Bestmed Medical Scheme

My experience with Bestmed has been extremely disappointing. Communication regarding rejected claims is unclear and often evasive. When I asked for a detailed explanation of why certain claims were declined, I did not receive a direct answer explaining the reasoning or the criteria used to make the decision. Instead, responses typically avoid addressing the specific question and provide general statements without clarifying the underlying logic behind the claim decision. I escalated the matter to senior staff, including the Head of Department and the complaints department. While I eventually received an apologetic response, the core issue—why the claim was rejected and what evidence or rules were used to make that determination—remains unanswered. Only after I indicated that I might approach the Council for Medical Schemes (CMS) for assistance did I receive further correspondence. However, even then, the response did not provide the technical reasoning behind the claim rejection. As a member, all I am asking for is transparency: 1. What evidence was used to evaluate the claim? 2. Which specific scheme rules were applied? 3. Why does the scheme consider part of the claim outside the benefits? Without clear answers to these questions, the process feels opaque and unnecessarily difficult for members trying to understand their benefits. Below is part of the response I received from Bestmed: "We confirm that your complaint was discussed by the Medical Advisors during the weekly Clinical Advisory Committee meeting. After careful consideration of the matter in line with the scheme rules and funding guidelines, it was suggested that you contact the Council for Medical Schemes (CMS) for independent verification and guidance." In my view, members should not need to approach the regulator simply to obtain a clear explanation of their benefits. Based on my experience, I would recommend that potential members carefully compare alternatives before choosing Bestmed. I am personally considering moving to another scheme such as Bonitas, due to the ongoing difficulties I have experienced in obtaining clear and transparent claim explanations.

I am so disappointed in the service received from BestMed. I applied for PMB benefits to see my psychologist, a person I have been seeing for the past 4 years, who knows my history etc. BestMed pended my application because they want a letter from a psychiatrist. I’ve never needed to see one to get my PMB approved with Discovery. I understand that each scheme has their own rules, but when I queried the decision and rationale, I was told they don’t know my history so cannot approve my psychologist’s request. So they are expecting me to go for several sessions with a psychiatrist, depleting my savings, just because they don’t deem the person who has treated me for 4 years fit and proper to make a diagnosis. Way to go BestMed. I’ll be moving back to Discovery at the end of the year. I’d rather deal with them and have access to the care I need than stay with a scheme who does not care about my mental health! I wish I had read the reviews before I made the switch, this was honestly the biggest mistake I have made for both myself and my family’s care.

I love knowing I have a medical aid that genuinely cares about you as a person, instead of just seeing you as a number. Real people for real life issues. They don't just talk the talk, but they walk the walk. Thanks Bestmed, for giving it your best!

App not working correctly. I was told to contact customer services, they replied & asked for my member number which I supplied. This is 3 weeks ago with no further communication. I am a pensioner and cannot afford to spend a long time on the phone. The 'new' app is really not as good as the previous one. Very disappointing. There should've been Teams/Zoom sessions explaining how it works.

Not even a week on the scheme and I am already regretting switching to them. From "misplaced" info from the treating doctor. To incorrect claims processing leaving me with R0 savings and a don't care attitude for their mistake. I am referring this matter to the ombudsman because this medical aid has put my life at risk because I am now not able to continue with treatment which has been uninterrupted since 2017.

They do not even deserve a star. You provide the most unprofessional service, can't give proper feedback on queries and misinform members when joining. Cancelling myself, my wife and definitely advising everyone in my network not to go with this them. I will advise everyone who has problems to write your complaint to the council of medical aid schemes (CMS)

BestMed saved my life. I joined just seven months ago, and on the 14th of October, I was diagnosed with a gallstone. An emergency operation was performed on the 16th. I received my pre-authorisation code within two days and went to one of BestMed’s partner hospitals. I'm on the BestMed Beat 2 Plus plan. After a co-payment of R3,600 and one operation, the gallstone—about the size of a squash ball—was successfully removed. BestMed covered 80% of all the costs without any issues. If this operation hadn’t been done in time, things could have turned out very differently for me. Thank you, BestMed—I truly appreciate it.

I’ve been a paying member of BestMed’s BEAT2 Network Plan since April 2024, and I am extremely dissatisfied with how my first hospital claim has been handled. I went to a network hospital, which should be fully covered under my plan. To my surprise, I was informed that the hospital’s fees must be paid from my savings account. On top of that, BestMed refused to pay for several items that the hospital claimed for when performing medical tests — stating they “don’t cover” those materials. If this is truly a network hospital, the medical aid and the hospital should be aligned on what is billable and what isn’t. It’s unreasonable to expect members to navigate billing disputes between two contracted parties. When I called BestMed to get clarity (Ref: 8286026), I had to spend over 15 minutes explaining the issue — that I was referring to items completely unpaid, not those “partially covered.” Despite this, the call consultant repeatedly gave me a generic explanation about scheme rates instead of actually reviewing the claim. It was clear she hadn’t looked at the account details, which was incredibly frustrating. Before that, I tried using the BestMed WhatsApp line (Ref 8285735), only to be told to send an email to another address. What’s the point of having a WhatsApp service if members can’t submit queries or have them logged properly? To make matters worse, the agent I was chatting with (Tabang) stopped responding mid-conversation. After I followed up 12 minutes later, I was told there was a “system delay” — and then the chat was closed for inactivity. This entire experience has been frustrating, inefficient, and disappointing. I expected better service and accountability from my medical aid. Please can someone competent from BestMed contact me to resolve this issue. If I have available savings in my account, there is no reason these valid hospital charges should remain unpaid.

SEE also the follow up below, after the absurd response and excuse from Bestmed to my previous review and post. I am unable to rely to their response. STAY FAR AWAY from Bestmed. They are unethical and do everything they possibly can to make sure they don’t pay for claims and hospital procedures! Absolutely DISGUSTING medical aid scheme. ***FOLLOW UP AFTER BESTMED REPLY*** RUBBISH!!!! A thorough investigation was certainly NOT done by Bestmed. Letters from the surgeon, whom Bestmed based their decision to terminate, very clearly stated that the condition could not possibly have been known prior to the emergency visit in July 2025. Bestmed is very sly in getting out of paying for anything. This scheme takes monthly contributions and never wants to pay for medical treatment. If Bestmed DID actually do a full and thorough investigation they would have checked all hospitals, pathologists and radiologists in South Africa (As we consented to), but instead, refuse to do a thorough investigation, because then they would be required to reinstate my daughters medical cover and pay for her surgery. ALL proof and evidence was submitted to Bestmed, they want to know nothing of it. All because my daughter stated that she had CRAMP LIKE pains intermittently for the last twelve months which could have been period pains or stress induced, which was exactly what she thought, and what she told the referring surgeon at the consultation. So why on earth would she put that on the application form as a pre-existing condition? For goodness sakes! It’s plain and simple, Bestmed just want to take a member’s money monthly, but they find any and all excuses not to pay for treatment.

STAY FAR AWAY from Bestmed. They are unethical and do everything they possibly can to make sure they don’t pay for claims and hospital procedures! Absolutely DISGUSTING medical aid scheme. My 22 year old daughter has been on Bestmed since 01 Dec 2024, she ended up in the emergency room on 28 July 2025 with severe and crippling pain. Scans were done and it was determined that she had an inflamed gallbladder and a gallstone 5cm in size. She scheduled surgery as recommended by 2 surgeons. While awaiting the authorization, she received calls from the emergancy room accounts department, the pathologist, radiologists AND the surgeons rooms, stating that she is liable for the cost of her emergancy visit as Bestmed had rejected the claim and refused to pay because my daughter had not gotten pre authorization to go to emergancy. BUT THATS NOT ALL!!!!!! After numerous calls, emails and follow ups with Bestmed to get authorization for the already scheduled surgery that was booked for Monday 22 September 2025, an email was sent by Bestmed late Friday afternoon (after 4pm) stating not only that they would not be providing authorization for the surgery, but they had actually TERMINATED her membership and medical cover with immediate effect. Their reasoning…. NON DISCLOSURE of medical condition. But if you remember what you read right at the beginning of this post, my daughter joined Bestmed 01 December 2024, and she was diagnosed with inflammation and gallstones on 28 July 2025. The scheme has state non disclosure because of ONE SENTENCE written in a referral letter from the surgeon, stating that my daughter has suffered intermittent cramp like pains for the last 12month. So according to Bestmed, because she had cramp like pains every couple of months, she knew she had gallbladder problems!!!! Have you ever heard of anything more ridiculous in your life?! We have submitted an appeal, the surgeon has written letters, we have submitted affidavits, we have followed “the rules”. Never been dishonest, never hidden anything. In our appeal we ever gave written consent for Bestmed to source all and any medical history for all pathologists, radiologists, hospitals and medical practitioners in the ENTIRE South Africa. The condition was unknown upon initiating with the medical scheme. They stand by their decision and refuse to reinstate her medical cover. And on top of that, they stated that all claims she has made over the year she has had her membership with Bestmed, must be paid back to the scheme. We will be initiating a complaint against Bestmed with the Complaints Against Medical Schemes (CMS) and will take this matter further. I have also contacted legal representation regarding this disgusting and unethical behaviour from Bestmed, and they were absolutely shocked after we provided them with all the correspondence, evidence and proof (which was also sent to Bestmed). Since our issue with Bestmed, we have heard SOOOO many people who have similar complaints and issues. Bestmed is very quick to take your money for premiums, but as soon as help is needed for medical care, Bestmed finds ways to always get out of paying for treatment. STAY AWAY from Bestmed!!!!! Honestly… you might as well be throwing your money into a fire pit. My husband and I have since terminated our membership with Bestmed, and other family members have also voiced their concern with this issue and lack of confidence in the scheme, and they too will be terminating their membership.