AvdW
Andrew van der Watt
1 reviews | Active since Mar 2009
19 Oct 2015, 10:34
Believes its above the CMS's PMB law
I have been a chronic epilepsy patient for the last 14 years.<br> I recently went for an annual check-up, which legally has to be paid as its a PMB.<br> Discovery always used to pay about half the claim (as their tariff rates are just so low), for all three claim lines (effectively an EEG and a consult). This year they decided that an EEG is \diagnotic"therefore won't be paid as part of ongoing treatment. Keep in mind that Discovery has been paying the previous invoices with exact same items for years!<br> As a medical aid (that is a non-profit that exists for the sake of its members)"
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Discovery Health's replyOfficial
29 Oct 2015, 14:28Hello andrew50,
Thank you for your comment.
Prescribed Minimum Benefits (PMBs) are legislated and every medical scheme in SA is required by law to fund a pre-defined list of approximately 270 conditions and 27 chronic conditions. The level of cover is equivalent to that which is available in State. Therefore, irrespective of one's personal plan-type, you are entitled to these benefits. The Chronic Illness Benefit (CIB) covers 27 conditions on all plans as prescribed by legislation according to treatment guidelines. CIB also covers a specified list of consultations, procedures and tests which are required for the diagnosis and ongoing management of these conditions.
These treatment guidelines are updated annually and as such certain treatments could be added or removed. We confirmed that your treatment was removed however our Clinical Team confirmed that we will review the treatment once we receive motivation from your treating doctor. I have emailed you further information in this regard and we await the necessary information to assist you further.
Regards
Jashvir
Thank you for your comment.
Prescribed Minimum Benefits (PMBs) are legislated and every medical scheme in SA is required by law to fund a pre-defined list of approximately 270 conditions and 27 chronic conditions. The level of cover is equivalent to that which is available in State. Therefore, irrespective of one's personal plan-type, you are entitled to these benefits. The Chronic Illness Benefit (CIB) covers 27 conditions on all plans as prescribed by legislation according to treatment guidelines. CIB also covers a specified list of consultations, procedures and tests which are required for the diagnosis and ongoing management of these conditions.
These treatment guidelines are updated annually and as such certain treatments could be added or removed. We confirmed that your treatment was removed however our Clinical Team confirmed that we will review the treatment once we receive motivation from your treating doctor. I have emailed you further information in this regard and we await the necessary information to assist you further.
Regards
Jashvir
Discovery Health's reply29 Oct 2015, 14:28
Official
Hello andrew50,
Thank you for your comment.
Prescribed Minimum Benefits (PMBs) are legislated and every medical scheme in SA is required by law to fund a pre-defined list of approximately 270 conditions and 27 chronic conditions. The level of cover is equivalent to that which is available in State. Therefore, irrespective of one's personal plan-type, you are entitled to these benefits. The Chronic Illness Benefit (CIB) covers 27 conditions on all plans as prescribed by legislation according to treatment guidelines. CIB also covers a specified list of consultations, procedures and tests which are required for the diagnosis and ongoing management of these conditions.
These treatment guidelines are updated annually and as such certain treatments could be added or removed. We confirmed that your treatment was removed however our Clinical Team confirmed that we will review the treatment once we receive motivation from your treating doctor. I have emailed you further information in this regard and we await the necessary information to assist you further.
Regards
Jashvir
Thank you for your comment.
Prescribed Minimum Benefits (PMBs) are legislated and every medical scheme in SA is required by law to fund a pre-defined list of approximately 270 conditions and 27 chronic conditions. The level of cover is equivalent to that which is available in State. Therefore, irrespective of one's personal plan-type, you are entitled to these benefits. The Chronic Illness Benefit (CIB) covers 27 conditions on all plans as prescribed by legislation according to treatment guidelines. CIB also covers a specified list of consultations, procedures and tests which are required for the diagnosis and ongoing management of these conditions.
These treatment guidelines are updated annually and as such certain treatments could be added or removed. We confirmed that your treatment was removed however our Clinical Team confirmed that we will review the treatment once we receive motivation from your treating doctor. I have emailed you further information in this regard and we await the necessary information to assist you further.
Regards
Jashvir