Rejected Covid test claim

I visited Wilmed Park Hosp in Klerksdorp on 04.08.2021 as I was having flu like symptoms. The DR on duty deemed it necessary to send me for a Covid test. The tests came back negative but it was found that I have an upper respiratory tack infection and she gave antibiotics and booked me off.

I am now informed that the bill for these tests with AMPATH was rejected by my medical aid. An amount owing by me to AMPATH, R1440.46.

Why is my claim being rejected when your website clearly states the following: WHAT ARE YOU COVERED FOR?

COVID-19 treatment, including the vaccine, is considered a Prescribed Minimum Benefit (PMB), and we therefore assure you that Bonitas Medical Fund will cover the cost of the vaccine and clinically-approved treatment which members currently require to manage the COVID-19 infection.

Criteria for the payment of tests We will pay for COVID-19 diagnostic tests from risk, whether the result is positive or negative, provided that the member who took the test:

· Showed symptoms for COVID-19 which include;

o Severe acute respiratory illness

o With a fever or history of fever and/or

o A cough and / or

o Sore throat and / or

o Shortness of breath or difficulty breathing.

· Was in contact with an individual with the virus; and

· Was referred by a healthcare practitioner (doctor or nurse).

The services covered as a PMB will include:

· 2 screening consultations by a GP, specialist or nurse. This includes virtual consultations.

· PCR tests (member needs to be referred by a healthcare practitioner) – limited to 3 tests.

· Rapid-antigen COVID-19 tests (member needs to be referred by a healthcare practitioner) – 3 tests, limited and included in the PCR tests benefit 3 tests.