Bankmed
Refusal to pay for diagnosis for a PMB condition

I went to the doctor for a problem I have had for a year. The doctor suspected Rheumatoid arthritis, sent me 4 blood test and xray. I called bankmed and asked if they will pay, they said no, no savings, no pay. I read through their website the Medical Schemes Act: Prescribed Minimum Benefits (PMBs) are a feature of the Medical Schemes Act, in terms of which medical schemes have to cover the costs related to the diagnosis, treatment and care of: a limited set of 270 medical conditions (defined in the Diagnosis Treatment Pairs); and 25 chronic conditions (defined in the Chronic Disease List). It clearly state they should pay 4 diagnosis regardless of what kind of medical plan i have. Before going 4 blood test i confirmed what was written and after much debate they said yes they do pay 4 diagnosis if the codes are correct. I read the codes written n the lady said yes they are part of icd 10 codes. Today I received sms from pathologist saying medical aid refused to pay. I called bankmed again today n again argued with the lady about this diagnosis statement because she keeps saying (like last week) I need to be registered under the chronic care. How will that happen without diagnosis?

Company: Bankmed
Country: South Africa
City: Johannesburg

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