1 reviews | Active since Mar 2020
Patients health is not top priority
My husband has sleep apnea. He had tests done and it is severe. Approximately 6/7 years ago bestmed authorized a machine RESmart. It helped tremendously but the machine has not been working properly for about a year due to its age. My husband went to the cardiologist and got a letter stating that the machine is not providing the needed therapy. Also my husband has high blood pressure and is on chronic medication for it. We were always on the pace 1 option but went down one option to beat 3 when covid happened. We sent in the letter from the cardiologist and this is what bestmed rep****
Thank you for your e-mail received on 07 October 2022. I would like to respond to your e-mail as follows:
Although your sleep study result does meet the Scheme’s protocols, we regret to inform you that on your option plan medical appliances are funded from the medical savings account, which has been exceeded. The member will be fully liable for payments towards the CPAP machine and accessories.
Read below the danger of sleep apnea. And because we went down an option they decline treatment. As a medical scheme should a patients health not be top priority???
14.6. Sleep apnoea resulting in cor pulmonale is a Prescribed Minimum Benefit (PMB) condition under Diagnosis and Treatment Pair (DTP) code 910C. The DTP describes sleep apnoea as "Chronic upper airway obstruction, resulting in cor pulmonale." The treatment component set forth is "Surgical and medical management." 15.
The case was reviewed and we regret to inform you that based on the information received, the request does not meet the PMB funding criteria. Cpap machines can only be funded from the available out-of-hospital benefits in accordance with the benefit option design.
Regards
Katlego Sithole
The case was reviewed and we regret to inform you that based on the information received, the request does not meet the PMB funding criteria. Cpap machines can only be funded from the available out-of-hospital benefits in accordance with the benefit option design.
Regards
Katlego Sithole
