Appalling no response in a month

To date there has been no response to the initial emails sent a month later and still nothing resolved.

Facility: Olivedale Hospital ***, Case ***, Receipt ***, Admission 12 Sep 2026 19:05, Amount R9,234.66 paid under duress

I appeal co-pay and request claim reprocessed as PMB emergency with full refund.

1.⁠ ⁠Coding error: Authorisation shows Primary ICD-10 R06.0 (shortness of breath). R06.0 is a symptom code only, not final diagnosis. It was used to get emergency bed. Final diagnosis is rhinovirus lower respiratory infection with hypoxia requiring O2 admission. R06.0 cannot be used to decline PMB — scheme must consider full clinical picture per CMS.

Please request update to: J12.89 Viral pneumonia + B97.89 Rhinovirus + J96.90 Respiratory insufficiency with hypoxia — which is PMB 903J/D19.

2.⁠ ⁠Clinical evidence (photos attached): • ER vitals Sat ∼19:30: SpO2 93% ON O2, HR 149-153, RR 37-38 • On O2 trolley with nasal cannula, IV, portable cylinder in hospital lift to paediatric ward — cannot be transferred to DSP • Admission required overnight O2

3.⁠ ⁠BonCap emergency rule: After hours closest facility, O2 dependent child, parent cannot seek DSP. Emergency at any private hospital must be covered with no co-pay penalty, even if not PMB. Regulation 8(3).

I paid R9,234.66 under duress to secure O2 bed.

Request:

A) Update ICD-10 from R06.0 and approve as PMB emergency B) Refund R9,234.66

Attachments: 1. Authorisation showing R06.0 + Case *** 2. Monitor showing 93% on O2 3. Photo on O2 trolley in lift 4.Receipt *** R9,234.66 5.Triage report

Please resolve within 5 business days if unresolved i will lodge a PMB complaint with CMS for incorrect coding and co pay on an emergency admission.