I (Elize Fouche) have third party consent on my Nephew's medical aid. He was in a motor vehicle accident (PMB), on 30 November 2012, which left him paralysed. On 05 March 2013 a claim and motivational letter from the hospital case manager, was sent through, for medical equipment (wheelchair etc) On 13 March 2013 the wheelchair etc was paid by Discovery Health (R24 352.36) only to find out about 2 weeks later, that they have reversed the amount for the wheelchair (R20 648.25). When I phoned to query this, I was told that the incorrect Nappi Code was supplied by CE Mobility Services. My question is... how can a claim be assessed, authorised and paid and only after paying it Discovery Health discover that they have paid using an incorrect Nappi Code (141769-001). If we were told upfront that they don't pay, we could have made a plan for payment, but they created the expectation that it is settled. The reversal of this claim will put a lot of financial strain on the member as all spare funds have been utilised for disposable nappies, medication, other unpaid bills etc. As this is a PMB wouldn't a wheelchair be considered a "prescribed minimum benefit" for a paraplegic?
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