Im a member of the Nedgroup Medical Aid Fund administered by Medscheme
After a suspicios biopsy on my thyroid a lobectomy removal of one lobe was done and sent for pathology.
Cancer was diagnosed and the other lobe removed.
The accounts sent by the anaethetist and the surgeon as per the diagnosis were sent for payment with ICD code C 73 a PMB
The aneathetist and the surgeon were paid at scheme rates for the intitial surgey and PMB rates for the second surgery after the cancer diagnosis even though the ICDs were updated as per the PMB diagnosis of cancer
After hours of frustration on the phone to these guys I got nowhere and my calls not returned.
The doctors have stated that they will take this up an i must concentrate on getting well.
One however expects the medical aid to support you in these times however.
Was the doctor on the initial ICDs quoted for surgery/authorization supposed to and put a PMB code
This could only be done after diagnosis by the pathologist. Try explain this to them
Left now with substantial pay in
They are blatantly in transgression of the act and I will now FWD this to the medical shemes council on monday to see if they can take action
Rgs
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