Medical aid not paying for pmb

<p>My 3 year old daughter was playing at home in September this year and ran into the corner of the door, cutting her forehead open with a very deep gash. We rushed her to St Augustines and had her stitched up by a surgeon. She went into theatre for 45 Min for for this. Our medical aid paid did not settled the full amount and so we claimed from gap cover. The claim was rejected due to the claim ring for a pmb which all medical aids are obliged to top over in full. Discovery is not not accepting this as a pmb and wants a whole lot of letters to motivate it being a pmb. This is so disgusting. How can such an emergency not be looked at as a pmb? All the doctors and our gap cover have confirmed that this is definitely a pmb. The fact that we we cannot rely on our medical aid in emergencies is early worrying. this means that we to send motivation letters and fight them to pay when we need them but they they don't have to fight us to pay them monthly. </p>