1 reviews | Active since Feb 2012
non payment of specialist :code 81.1 PMB
<p>SPECIALIST VISIT CLAIM IS BEEN REJECTED .MY GP DR BRINK GAVE ME A REFERALE LETTER WHICH I GAVE TO RECEPTION LADY.</p> <p><br /> I VISIT DR M VISSER ON 13 OCTOBER 2016 WRT MY DISABILITY. MY CODE IS 81.1 PRESCRIBE MINUMUM BENEFITS AND ALL MY ACCOUNTS HAVE TO BE PAID.</p> <p><br />PLEASE I DO NOT ENERY TO START AGAIN FIGHTING<br /> ******************************************************************<br />Please find attached a copy of your account for Dr M Visser<br /> <br />Kindly note your claim has been rejected by your Medical Aid<br />Please settle this amount within 15 days<br />Proof of payment is to be sent to ********** or<br />faxed to ********** 856.<br /> <br />Regards</p>
Hello Salomek,
Thank you for submitting a comment to us through Hello Peter.
This is to confirm that we have received your comment and that we are currently investigating this matter.
Our representative will be in touch with you shortly to discuss this matter and ensure that it is speedily resolved.
Kind regards
Bonitas Team
Hello Salomek,
Thank you for submitting a comment to us through Hello Peter.
This is to confirm that we have received your comment and that we are currently investigating this matter.
Our representative will be in touch with you shortly to discuss this matter and ensure that it is speedily resolved.
Kind regards
Bonitas Team
Closure of Query [MI ********** 32 refer STILL NOT RESOLVED
All my treatments, professor Mennen and orthotics prosthetics bills for my brace since20 June was paid as G81.1 PMB.
NO HASSLE, WHAT CHANGED, I still has a brain injury as from birth?
I MADE IT CLEAR ON THIS ENQUIRY THAT MY CONDITION IS CLASSIFIED AS A PMB code 81.1 ******* Hemiplegia and THEREFORE my bills must not be deducted from day to day.
My condition is a PMB (ICD CODE G81.1) and was capture on 20/6/2016 as such.
Please take note: “regulation 8 of medical Scheme act. The medical aid/scheme is legally obliged to pay in full. Failure to pay in full by the Scheme is a transgression of the law and your scheme should be reported to COUNCIL OF MEDICAL SCHEME."
See documentation from Professor Mennen confirming that I have a PMB CONDITION. Letter was sent on 20/06/2016 to bonitas.
DR Visser did claim on this Code g 81.1, THUS HER BILL MUST BE PAID AS A PMB. PLEASE CORRECT PAYMENT AS A PMB.
I am schedule for my next operation for my hemiplegia right foot to enable me to walk without pain and dragging my foot.
CAN A NOTE AGAIN BE MADE THAT ALL my claims wrt this CODE g81.1 are PMB BE PAID AND HANDLE AS SUCH
Please read for self-explanatory as quoted
Council for medical Schemes STATES
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.
The Regulations to the Medical Schemes Act in Annexure A provide a long list of conditions identified as Prescribed Minimum Benefits. The list is in the form of Diagnosis and Treatment Pairs (DTPs).
The 270 conditions that qualify for PMB cover are diagnosis-specific and include a range of ailments that can be divided into 15 broad categories:
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).
PMB Category
Musculoskeletal system (muscles and bones); Trauma NOS Fracture of the hip
G81.1 ******* hemiplegia is a neuromuscular condition of *******ity that results in the muscles on one side of the body being in a constant state of contraction. It is the "one-sided version" of ******* diplegia. It falls under the mobility impairment umbrella of cerebral palsy.
AND
Medscheme definition as per web site
What are PMBs?
Minimum Benefits (PMB) are 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 members with continuous care to improve their health and well-being and to make healthcare more affordable.
Closure of Query [MI ********** 32 refer STILL NOT RESOLVED
All my treatments, professor Mennen and orthotics prosthetics bills for my brace since20 June was paid as G81.1 PMB.
NO HASSLE, WHAT CHANGED, I still has a brain injury as from birth?
I MADE IT CLEAR ON THIS ENQUIRY THAT MY CONDITION IS CLASSIFIED AS A PMB code 81.1 ******* Hemiplegia and THEREFORE my bills must not be deducted from day to day.
My condition is a PMB (ICD CODE G81.1) and was capture on 20/6/2016 as such.
Please take note: “regulation 8 of medical Scheme act. The medical aid/scheme is legally obliged to pay in full. Failure to pay in full by the Scheme is a transgression of the law and your scheme should be reported to COUNCIL OF MEDICAL SCHEME."
See documentation from Professor Mennen confirming that I have a PMB CONDITION. Letter was sent on 20/06/2016 to bonitas.
DR Visser did claim on this Code g 81.1, THUS HER BILL MUST BE PAID AS A PMB. PLEASE CORRECT PAYMENT AS A PMB.
I am schedule for my next operation for my hemiplegia right foot to enable me to walk without pain and dragging my foot.
CAN A NOTE AGAIN BE MADE THAT ALL my claims wrt this CODE g81.1 are PMB BE PAID AND HANDLE AS SUCH
Please read for self-explanatory as quoted
Council for medical Schemes STATES
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.
The Regulations to the Medical Schemes Act in Annexure A provide a long list of conditions identified as Prescribed Minimum Benefits. The list is in the form of Diagnosis and Treatment Pairs (DTPs).
The 270 conditions that qualify for PMB cover are diagnosis-specific and include a range of ailments that can be divided into 15 broad categories:
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).
PMB Category
Musculoskeletal system (muscles and bones); Trauma NOS Fracture of the hip
G81.1 ******* hemiplegia is a neuromuscular condition of *******ity that results in the muscles on one side of the body being in a constant state of contraction. It is the "one-sided version" of ******* diplegia. It falls under the mobility impairment umbrella of cerebral palsy.
AND
Medscheme definition as per web site
What are PMBs?
Minimum Benefits (PMB) are 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 members with continuous care to improve their health and well-being and to make healthcare more affordable.