Discovery Health
PMB claim shortfall

Regarding Danita De Witt response to my previous complaint of a PMB payment shortfall of R3371 for account for Dr NM of 21/07/2013.

You quote the definition of emergency medical conditions. However this applies to conditions that are NOT listed as PMB conditions if you would care to read the general regulations in terms of the Medical Schemes Act of 1998.

I had a LISTED PMB condition (353H). I needed immediate surgical intervention. According to regulation 8 (3) (a) of the general regulations my use of a non designated service provider was "involuntary" as I required "immediate medical or surgical intervention".

The act provides that conditions that need immediate treatment do not require a copayment from members.

Discovery must therefore pay the Doctors account "in full".

Company: Discovery Health
Country: South Africa
City: National

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