1 reviews | Active since Oct 2010
Refusal to pay in emergency
After being rushed to hospital for a concussion (and loss of consciousness), the radiologists informed me that I had to pay up front for a CT scan because Discovery refused to pay. Flustered and not a little disappointed, I spoke to the doctor who assured me the legal Prescribed Minimum Benefits has me covered, Discovery will pay, don't worry.<br> Now a week later I'm still trying to explain the law about health schemes, to my health scheme!<br> Why do I always have to fight with Discovery, to get them to do their job? It's not like I went to hospital for a runny nose, this is an injury clearly listed in Annexure A of the Medical Schemes Act.<br> It seems Discovery thinks they can get away with shirking their responsibilities because so many people are stuck using them due to employer agreements.
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. For us to fund the claim in question from PMB we need to have a confirmation that the diagnosis is a PMB by means of supporting information. I have sent you a detailed email with further information regarding your query and what information is required for us to review your claims. We look forward to receiving this so we may assist you further with your query.
Thank you for allowing us 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. For us to fund the claim in question from PMB we need to have a confirmation that the diagnosis is a PMB by means of supporting information. I have sent you a detailed email with further information regarding your query and what information is required for us to review your claims. We look forward to receiving this so we may assist you further with your query.
Thank you for allowing us to assist you further.
Regards
Jashvir