PMB but not a PMB

PMB is defined as follow by the Counsel for Medical Schemes:

Prescribed Minimum Benefits (PMB) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable. PMBs are a feature of the Medical Schemes Act, in terms of which medical schemes have to cover the costs related to the diagnosis, treatment and care of: any emergency medical condition; a limited set of 270 medical conditions (defined in the Diagnosis Treatment Pairs); and- 25 chronic conditions (defined in the Chronic Disease List).

We app**** for PMB benefits for my wife and it was approved as from 03/06/2019. The limitation is that there are a maximum of 15 visits to the relevant doctor until 31/12/2019.

We received a confirmation that the benefit was exhausted but then the payments already made to the doctor were reversed as there was an overpayment done according to the scheme.

I investigated and found that the payments for the 15 visits were all made from my Day-to-Day benefits. This is contrary to the definition of a PMB and this was not explained at any point during the application process.

So now nothing has in effect been paid as PMB as it was all paid from my day-to-day benefits, the benefits are exhausted and I now owe the doctor. The explanation given by the PMB department is unacceptable as it means that I am on a plan where I don't have PMB seeing as the claims get paid from my benefits in any case.

When raising this the consultant basically read off a sentence about how this was approved and how they work, but this is basically a good way to tell me to get a medical aid that doesn't tell me to bend over.

I find this unacceptable and had I any confidence in the NHI, I would be the first to vote that medical aids like this be closed down.