PMB condition related

Unacceptable that I have submit the pre assessment days ago, still no feedback. Today I was informed it was not received. Now 3 days past and told if I submit today, 3 days waiting will be again

Let me again start from the beginning.

This operation is related to my PMB code G80.2. According to law treatment must be paid, as it will improve my quality of life.

When ICD 10 and procedure codes were provided to obtain hospital authorization, it specified exact what operation entitles, right foot triple arthrodesis, and NOT only as per your letter "Follow-up care to remove pins and/or plates following surgery of the musculoskeletal system" I did send a previous email wrt the diagnosis on the letter, I questioned. Although the hospital received the correct icd 10 and procedure codes from Discovery.

The following ICD 10 and procedure codes was provided by me, as received from my doctor.

ICD10 code G80.2 - ******* hemiplegic cerebral palsy, my approved PMB condition

Procedure codes: 0605/0051- stabilization of foot (triple-arthrodesis)

05592 x2 - Synovectomy Large joint.(0592)

0884 x2 - Removal of internal fixatives or prosthesis: Less accessible (0884)

ICD10 code: M21.47 - Flat foot [pes pl****] (acquired), right foot

Procedure codes: 0593 - Tendon synovectomy.

0837- Open elongation tendon Achilles (0837)

0009 fee for an assistant

ICD10 code: Z47.0: Aftercare following joint replacement surgery

It seems that the ICD10 code Z47.0 was considered a full diagnosis for letter purposes.

With all the procedure codes it is no brainer that hardware will be used.

The hospital however did receive the correct detail from Discovery.

My hospital authorization letter and even in hospital PMB guide was forward to me. Auth no ***7

I enquired about prosthesis rand limit as doctor’s room requested it, I was informed as this is PMB related, and it would be paid.

As doctor’s room requested a rand value, I phoned in again and requested prosthesis limit, I was informed that on my plan, only big prosthesis like hips ext are available, I can complete the pre assessment and attach quotes to see what will be paid.

I although AGAIN mentioned that this is related to my PMB and why would it then not be paid.

Then the madness start, the up and down submit and resubmit the pre assessment and silly email replies. Re submitted for 3rd time reference number is ***.

Never had I ever struggled so much. As it the prosthesis rand value was visible on Bonitas websites and plan brochures you exactly knew. In my case as it was PMB related it was paid in full and no nonsense that it was limit to big prosthesis. I was on the Standard Plan.

As a result of this ongoing issue when I ONLY want a Prosthesis limit, and no answer since the 8th of February 2024, I requested my HR partner to prepare a medical aid switch as soon as possible to Bonitas for me to sign when I return to work.

I will then be forced to cancel my funeral policy, which I moved to from Standard Bank as I will not be qualifying from the discounted premium. It would be a shame as it suite my pocket and needs.

I had such high hopes that Discovery client service would be better. But now a single question makes the difference. A call to Bonitas hospital authorisation, more than a dozen to Discovery.

I ONLY NEED THE RAND VALUE PROSTHESIS LIMIT why is it so difficult to answer!!!!!!