Prescribed minimum benefit (PMB): By law you can be treated for a PMB in any appropiate setting.
On the 20th of October my nearly 6 year old daughter fell from about a 2m high climbing wall. She had severe pain in her left foot and it was swollen. I went to the emergency department of the Umhlanga hospital. They examined the foot and did a x-ray. The diagnose was a fracture. I am on hospital plan - custom option - with Momentum. A fracture clearly is a PMB condition. You can be treated for a PMB in any appropiate setting.
Momentum on my first approach to them informed me not to pay as my daughter was not admitted to hospital. I then informed them they are misleading me as this is a PMB. The invoices from the emergency department as well as the X-ray department show it is a fracture.
This afternoon I phoned the Momentum clsim department to get a feedback and explain the PMB condition (received reference no. 187009748).
This evening I received an email from the Momentum claim department proofing non-payment for the PMB condition.
I am totally upset and will forward a complaint to the Council for Medical Schemes.
0 comments