Discovery not paying my claim in full. It is a PMB claim- see below. My 2 yr old son was involved in an accident. They say I used a non DSP voluntarily.
Here is the Act.
A medical scheme must pay in full for the diagnosis, treatment and care costs of the prescribed minimum benefit conditions (PMB's)...
The PMB's are broadly:
o Any emergency condition;
An emergency medical condition means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical treatment and/or an operation. If the treatment is not available, the emergency could result in weakened bodily functions, serious and lasting damage to organs, limbs or other body parts, or even death.
A medical scheme can appoint a designated service provider (DSP) - a doctor, pharmacist, hospital or healthcare provider and provide that the PMB condition will only be paid in full by the medical scheme if those services are obtained from a DSP. However, if the DSP is not available or in an emergency the scheme must pay in full for treatment from a provider who is not a DSP."
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