Claims rejected for PMB

My son was hospitalized after experiencing grand mal seizure. The neurologist who treated him sent him for MRI scan and EEG, which were performed while my son was still hospitalized. Subsequently my son was diagnosed with epilepsy. He is now on chronic medication, and Genesis is well aware about it. 1. The claim 244330 for EEG for R3282.60 was rejected with Note 19 – “No benefit for day to day treatment”. This note makes no sense as he was hospitalized at the time. 2. I had to pay R6750.00 as co-payment for MRI scan. As PMB condition this should be fully covered by Genesis. 3. The claim 244359 for R4216.30 for the rest of MRI fees was rejected with Note 36 – “Amount claimed is greater than the prescribed benefit”. Complained to Genesis over the phone but they advised to do it in the email; sent email a week ago, but received no response. I consulted with the National Office of Epilepsy South Africa and was advised that in terms of MEDICAL SCHEMES ACT, Annexure A, Epilepsy is one of “Diagnosis and Treatment Pairs”, code 902A, eligible for prescribed minimum benefits. This means that medical aid schemes are required to cover costs associated with the condition, including the costs of diagnostic tests and treatment. Special diagnostic tests for epilepsy, including MRI and electroencephalogram, are covered by all major medical aid schemes in South Africa, including Discovery and Bonitas. As a client of Genesis of 15 years I am extremely disappointed with these unsubstantiated rejections. I request Genesis to re-consider the rejections of the claims for EEG (R3282.60) and MRI (R4216.30) and refund my co-payment (R6750.00).