On Friday 30 Aug I had a terrible pain in my lower right abdomen. It was so bad that my work rushed me to the emergency room as my GP is fully booked and would only be able to see me at 15:30 that afternoon. The emergency room wanted to send me for CT scan to determine if appendix is about to go. It was denied. When Dr. Jordaan did physical tests, he said that it is the appendix and said he's not waiting and rushed me to theater after I've been struggling to be admitted as Medical Aid took their time. After surgery, the Dr told me that it was life threatening as the appendix was between 10 -15cm long and was hiding behind the colon. When I went back on Tuesday 10 Sept he showed the pathology report and told I was really lucky as it was bad. His offices also phoned me and told me that we need to make sure that the medical aid should pay the full amount as the codes that was sent through was life threatening as per PMB. Now I've received the claims from MH and we need to pay in R4320.78. 100% was not being paid. Is my annual limit only R21406.89 as some is said tariff exceeding. Do I need to see my GP every time if it is life threatening to ensure I can get all the benefits?
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