pmb unpaid

My son was involved in a soccer accident and 7 Jan 2025 went to RMC and was admitted 08/01/2025 Dr requested auth for Arthroscopy and DH declined. We asked for to upgrade his plan from Keycare Plus to Coastal saver, but they refused, I asked for leniency as it was technically only 4 working days late, but they still declined. The doctor sent LOM and radiology reports to *** but still declined. We asked to have it reviewed as PMB S82.00 W50.9 ACCIDENT BUT DECLINED BY DH - My question is if this same treatment was done in STATE why can't MEDICAL aid cover it under PMB - DTP in place since 2013 for PMB level of care and has not been updated since but no DH won't assist a 26 year to rehabilitate the knee, WHAT TYPE OF MEDICAL AID does this? Surely we have Ex Gratia and you can accommodate the upgrade 4 days late so that the procedure can be done?