Non complaince

I am writing to formally contest the rejection of my claim for Dr. MM Visser regarding the consultation on 9 December 2025.

The claim was rejected with the comment "Specialist referral required." However, this was a follow-up visit for a Prescribed Minimum Benefit (PMB) condition. The ICD-10 code G80.2 pertains to my PMB condition, and Dr. Visser is my designated PMB orthopedic specialist.

Referring to the "BONITAS MEDICAL FUND ANNEXURE B OPTIONS: STANDARD STANDARD SELECT 2026," signed on 18 December 2025” by Mifana Maswanganyi Registar of medical Schemes.

The Registrar of Medical Schemes has rejected the practice of denying such claims, thus you are committing *****. See page 5, paragraph B 8.

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As I am unhappy with the outcome of the internal complaint process regarding this matter, I request that this dispute be escalated immediately to the Registrar's office of the Council for Medical Schemes (CMS).