UNFAIR PMB RESTRICTIONS

Dear Sir/Madam,

RE: BUHLE MTHEMBU & Percy from PFA i WANT THESE CALL LISTENED TO! Authorisation Number: 117625 Pacemaker Insertion Date: 03/12/2024 Reference: Percy – ***

I wish to formally raise my concern regarding the difficulties experienced in accessing ongoing Prescribed Minimum Benefit (PMB) level of care following my mother’s pacemaker insertion on 03 December 2024.

From a clinical and PMB management perspective, once Boncap authorised and funded the pacemaker implantation procedure, it would be reasonable to expect that the standard post-pacemaker PMB management codes and follow-up care requirements would automatically flow through onto the patient’s care plan. Post-cardiac device management and follow-up are clinically indicated and form part of the standard continuum of care to ensure appropriate monitoring of device function, cardiac stability, and patient safety.

The requested PMB-related codes: • 1268 • 1269 • 1270

are not unreasonable requests, but rather align with standard post-pacemaker clinical management protocols and PMB level care requirements.

Unfortunately, despite my mother being an elderly dementia patient with multiple comorbidities and a documented history of significant cardiac instability, unnecessary administrative barriers continue to delay access to clinically appropriate benefits. Patients in vulnerable categories should not be required to repeatedly “jump through hoops” to access benefits that are clinically justified and directly related to approved PMB treatment pathways.

I would specifically like to acknowledge Ayanda from Hospital Authorisations, who was the only individual who demonstrated genuine interest in assisting us. She took the time to review my mother’s clinical history holistically and understood the severity of her condition and the challenges surrounding her ongoing care needs.

I have been assisting my mother with all correspondence and telephonic engagements with Bonitas since the ProSano days, and my details have historically been associated with her profile for care coordination purposes. It is therefore concerning that additional consent and repeated administrative requirements are now being requested despite the extensive historical correspondence already available on record.

It is deeply concerning that pensioners and medically vulnerable members continue to encounter increasing administrative burdens when attempting to access clinically necessary benefits, despite consistently contributing towards their medical scheme membership over many years.

I kindly request that this matter be urgently reviewed from both a clinical risk management and PMB governance perspective to ensure continuity of care and appropriate access to post-pacemaker management benefits.

Kind regards,