MM
Musa M
1 reviews | Active since Dec 2016
27 Nov 2024, 15:48
PMB BENEFITS ****
I am not satisfied with the service I am receiving from this medical aid Their wellness benefit states that it covers 21 days in hospital and 15 out of hospital consultations but their consultants advised that a patient does not benefit from both simultaneously which is nowhere stated in their policy I’m yet to receive feedback from them Considering changing medical aid next year
Helpful (0)
Replies (1)0
Replies (1)
Bestmed Medical Scheme's replyOfficial
28 Nov 2024, 13:17Thank you for reaching out to us regarding your benefits under the PMB ICD-10 code listing. We understand your concerns and appreciate the opportunity to provide clarity.
As per Section 902T of the PMB ICD-10 code listing, members are entitled to:
- Hospital-based management for up to 3 weeks per year (this includes inpatient electro-convulsive therapy and inpatient psychotherapy),
OR - Outpatient psychotherapy for up to 15 sessions per year.
These benefits are designed to ensure access to care while aligning with the scheme’s funding guidelines. Please note that the benefits are not designed to be utilized simultaneously.
The purpose of obtaining pre-authorization is to provide members with detailed information regarding the scheme’s funding rules and guidelines specific to their treatment plan. Pre-authorization also ensures that members are fully informed of the applicable benefits and any scheme-specific conditions. kind regards TP
Bestmed Medical Scheme's reply28 Nov 2024, 13:17
Official
Thank you for reaching out to us regarding your benefits under the PMB ICD-10 code listing. We understand your concerns and appreciate the opportunity to provide clarity.
As per Section 902T of the PMB ICD-10 code listing, members are entitled to:
- Hospital-based management for up to 3 weeks per year (this includes inpatient electro-convulsive therapy and inpatient psychotherapy),
OR - Outpatient psychotherapy for up to 15 sessions per year.
These benefits are designed to ensure access to care while aligning with the scheme’s funding guidelines. Please note that the benefits are not designed to be utilized simultaneously.
The purpose of obtaining pre-authorization is to provide members with detailed information regarding the scheme’s funding rules and guidelines specific to their treatment plan. Pre-authorization also ensures that members are fully informed of the applicable benefits and any scheme-specific conditions. kind regards TP