Bestmed Medical Scheme
Disappointing claim settlement

I want to express my deep disappointment in Bestmed's handling of claims and lack of transparency. I have been a Bestmed client for almost 3 years now, never missing a payment and not submitting any major claims until recently.

Recently I had a knee operation and obtained full authorisation from Bestmed. I informed them of all the procedures with their corresponding medical codes and they told me that they will cover 100% of the doctor's 150% rates. It is also stated explicitly on their website that all surgical procedures will be paid 100% for my specific scheme plan. Bestmed now refuses to pay 100% of the claim and after three attempts of discussing the matter (telephonic, email, walk-in centre), keeps on telling me that only the first procedure will be paid 100%, where after the second and third procedures will only be paid at 75% and 50% respectively.

This shows clearly that their website and authorization procedures are misleading as I have never been informed of the multiplier effect on multiple procedures beforehand! I found their staff also very unhelpful and irritated at this matter!

Company: Bestmed Medical Scheme
Country: South Africa
City: National

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