Fedhealth is an excellent medical aid, however it seems they look for reasons not to pay and each time it turns to a battle

Where do i Start ?

In July 2022 CMS ( Council for medical Schemes ) Made a ruling that The Scheme Fedhealth is hereby directed to fund the diagnosis, treatment, and care costs for the child’s PMB condition. In January 2024 i app**** for them to pay mu daughters nappies and their reply was: Nappies are normally funded from savings as an appliance. However, according to the CMS ruling of case ***x , the scheme must fund the diagnosis, treatment, and care of the PMB condition. I was then requested to apply for an Ex-Gracia payment and submit 2 quotes. I have done this as well, after i had to pay an consultation fee to get the documents completed by my doctor. After which the application for the Ex-gracia was declined. I then again contacted the CMS as my daughters condition is an ongoing PMB condition. - After a long investigation with back and forth and in my opinion the ruling clearly stated in 2022 that they should fund the care costs which includes the nappies the ruling of the CMS was clearly stipulated. 12. The Scheme is directed to fund the dependent's condition in accordance with Regulation 8(1) of the Act and through PMB entitlements. Now my concern is the following:

1. Will i be re-imbursed for the past years nappies i bought from my pocket in the form of a once off Ex-Gracia payment from my scheme? 2. How long will it take the fund now again to register her nappies under the condition (PMB) or will i buy it monthly and they re-imburse me on a monthly basis?