You pay, but we don't

I am a hospital service provider trying to have claims for services paid by Polmed. It is absolutely ridiculous that both in- and out of hospital al**** health services all come from the same allowance. Further, all al**** health professionals are paid from this one allowance. Therefore, my in-hospital claims for speech therapy are not being paid because one of the member's dependents received some out of hospital occupational therapy earlier this year. This member is terminally ill and now I am expected to track them down and contact them out of hospital so that I can have my accounts paid?? Why even pay monthly for a medical aid policy when this is the outcome and attitude when you really need them?