PMB claims always declined

Good day.<br> <br> In August we received confirmation from the scheme that they will cover some consults for our daughters paediatrician. To date from the 1st consult that was in September the claims have always failed and then I would need to contact to call centre to have the claim reprocess. <br> <br> The provider is submitting the details correct, how do you fail the claim when it is received. then you get a stupid comment from the call centre to say it is because the provider is a non network provider. The reason why it is a non network provider is because she know the full history of our daughter and the nearest network provider is 20min away and incase of emergency the hospital is next door.<br> <br> I can just image how the scheme must save with other member not querying the process and letting the scheme get away with not paying the provider. All that Bonitas will need to do is honour what they are saying and that is paying the consults that have been approved. Not for the member to always follow. <br> <br> Thing to add. The call centre staff and team leaders also need to be re trained as most would say the co-payment only applies with the DR changes over medical aid rates. which is not case