Bestmed Medical Scheme
Rejection of claim

I hardly ever use my medical aid and the one time I use it, they reject the claim!!!

I was violently ill and I went to casualty on 14 December 2012 for emergency treatment and provided the reception with all my details, knowing that they are a Primecure facility. They did not tell me that I have to do anything else. I was treated and 3/4 hours later dismissed. I only became aware that there was a problem with payment once I started receiving bills from the hospital, doctor and pathology lab in February 2013. Bestmed rejected the claim due to no authorisation being obtained.

I tried to get help through their call centre, but I have been bounced around for more than 2 hours. Nobody is able to assist me in getting the claims paid. I pay a monthly fee for medical aid for precisely this reason and I expect my medical aid to pay for it. No reasonable person would be able to know every detail of the claims process and I certainly did not know that I needed to get authorisation, apart from being ill and not thinking about it.

Why have I been paying Bestmed Medical Aid if they are now ducking their responsibility because of a technicality? I don't know what to do anymore.

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

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