UNFAIR PMB practice for elderly

PFA – My mother is on Boncap. She had a hip replacement five years ago and is currently dependent on a walker, which has now broken.

The scheme allows a benefit of R7,900 for this item; however, they will not accept a referral from a GP. Instead, they require a specialist to confirm the need for a walker.

This requirement is unreasonable given the current economic climate. As a state pensioner with limited financial means, my mother cannot afford the additional cost of a specialist consultation—especially considering that the scheme does not cover the specialist visit. This results in us having to spend thousands of rands just to access a benefit that is already approved.

A GP is fully capable of assessing and confirming the medical necessity for a walker in this case. Requiring a specialist referral places an unnecessary financial burden on vulnerable members.

During calls with both Client Services and Pre-Authorisation, I was informed that this policy is due to benefit abuse. However, applying a blanket rule penalises genuine cases like my mother’s, where the need is both clear and medically justified.

This approach is not aligned with fair and accessible healthcare and creates barriers for members who are already financially strained.