Not following the PMB medical aid rules

My father went for an emergency surgery, the doctor was not on the plan, fed health chooses to have a network of hospitals but there are no surgeons situated at the hospital on fedhealth network that is available for my plan so since it is emergency i assume they will pay but according to fedhealth it does not matter that it was life threatening situation.

Secondly i have approval for a pmb condition which is cancer. None of the claims are being approved as it is not been sent to the pmb department first before processing. The rules are if a PMB benefit doctors, scans and surgeries will be paid up to pmb/fedhealth rates. The consultant would not listen to me.

I am then told that even though my dad is admitted in hospital because the hospital didn't extend their authorization yet that they won't pay for a lifesaving CT scan. Note my dad is in icu, he is 80 years old.

When you have a life threatening condition fedhealth benefit will review an upgrade of your plan. I assume if they reviewed quicker then we wouldn't have all these expenses because the new higher option will cover but they taking weeks to review.

I am at the point of contacting the medical aid council and just reporting this scheme for blatantly not paying pmb conditions. I have asked to speak to a supervisor, the consultant refused to refer me to someone and he admitted that he had various other people he was dealing with at the same time as me.

This is the service they provide. I am not going to motivate for every single claim they receive when the condition is approved. It is ridiculous and i have had enough.