1 reviews | Active since Jun 2013
NON PAYMENT IN A CASE OF AN EMERGENCY
Dear Mr Soobramoney
Thank you for contacting us.
Feedback on claim for VD A****as
Our Clinical Department has advised us that the benefits on your plan type is richer than the benefits on the Prescribed Minimum Benefits (PMB). We were also advise us that the provider is no a Designated Service Provider.
PMB
PMB’s are a set of minimum benefits that, by law, must be provided to all medical scheme members. The cover it gives includes the diagnosis, treatment and cost of ongoing care for a list of conditions. The list of conditions is defined in the Medical Schemes Act 131 of 1998.
As per Regulation 7 of the Act, emergency medical condition is defined as - "the sudden and at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment of bodily functions or serious dysfunction of a bodily organ or part, or would place the person's life in serious jeopardy".
Legislation allows medical schemes to use risk tools to ensure that funding of Prescribed Minimum Benefits remains sustainable now and in the future.
Members are entitled to full cover as long as the below three requirements are met:
Valid medical condition
The medical scheme needs to be provided with sufficient diagnostic information to identify the condition and determine if the severity qualifies for the treatment requested.
Chosen treatment is included in the defined benefits
There are standard treatments, procedures, investigations and consultations for each PMB condition. The scheme is only required to provide cover for these defined benefits (except on appeal).
Participating healthcare professional and or hospital
The medical scheme is required to ensure that members do not experience shortfalls if they make use of healthcare providers (hospitals and doctors) that the Scheme has a specific payment arrangement with (except in the case of emergencies).
We wish you a wonderful day further.
If you have any more questions, please call us on ***, email ********** or visit www.discovery.co.za
Regards Ulaysha Pillay Discovery Health (Pty) Ltd On behalf of Discovery Health Medical Scheme
Dear soob
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards
Discovery Health Servicing Team
Dear soob
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards
Discovery Health Servicing Team
Dear soob
We have been in touch with you to answer your comments.
Regards
Discovery Health Servicing Team
Dear soob
We have been in touch with you to answer your comments.
Regards
Discovery Health Servicing Team
