On the 25th of dec my daughter fell frm the stairs n broke her right thumb, we were in Rusternburg. We took her 2 Ferncrest hospital. The Dr took Xrays n then explained tht she nids to be seen by a specialist as her thumb is broken. The specialist (Dr Potgieter) explained that an opp nids to be performed. He made an appntment 4 an opp 2 be done the next morning @ the Peglerae hospital. We gt there the next day at 7am n all docs wr completed n my child was taken 2 be operated. Then while the opp was underway, the receptionist called and told us that the medical aid just advised tht they only cover emergencies (pmb) but as far as I know, this was regrded as emergency as we confrmed wit Dr Potgieter the previous day. Bt nw the Medical Aid is rejecting the claim, cos of the icd10 code on the claim (they r saying its nt regarded as pmb) n the hospital wants me to pay, it seems lyk every1 is passing a buck. Wat I wud lyk to knw is y did they go ahead evn though they knw tht this is not regarded as pmb? I hav been liasing wit the accounts admin manager at hospital Thuso n medical aid, bt 2 my surprise I gt cal yesterday tht the acc has bin hnded to legal, evn thou this matter is still being sorted out
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