Key Health Medical Aid

We joined Key Health on 1 August 2020 with a 3-month waiting period, which I accepted as standard practice and signed the relevant acceptance. Upon joining, I found Key Health's response and assistance to be extremely good. Quick and easy to join.

Fast forward to 7 October 2020 when my husband was involved in a hit-and-run accident. When he had to be admitted to hospital, we were told that on one side of the hospital system it shows that we are active on the medical aid, on the same system it shows us as inactive. They will admit him, but I am liable for costs should the medical aid not cover this. I was also advised that due the fact that this was an accident, it will fall under PMB (prescribed minimum benefits), in which case medical aids cover costs.

The next day I was notified that the medical aid is declining authorization because I accepted exclusion of PMB's during the waiting period. Up until 8 October 2020 I never clearly understood exactly what PMB's are. This is where our battle started.

At NO POINT DURING MY APPLICATION TO JOIN KEY HEALTH did anyone explain to me what it meant that PMB's are excluded and forms part of the waiting period. I have never worked for a medical aid, therefore I am not fami**** with specific terms and terminology, and I am of the opinion that Key Health relies on the fact that as novices we accept whatever they stipulate.

I have contacted everyone I could at Key Health to appeal to them to authorize the treatment as it was an accident - not any elective treatment. Every time they decline. Contacted the Trustees - only to be advised they are placed under provisional curatorship. I appealed to the provisional curator, Mr. Johannes Seoloane - but up to today (28 January 2021) have not received any response. I submitted yet another appeal, this time to the Clinical Committee - declined again, because they do not want "one member to have more benefit than another". I am sorry, this is not good enough. My husband spent 5 weeks in hospital and has 12 months of rehab ahead.

We were 24 days short of our waiting period being completed. I begged and pleaded with them to authorize this for my husband - me and our children did not need to be part of that authorization. I was willing to pay extra for those 24 days that we needed - but they keep declining.

What is the purpose of having a medical aid if not in case of an accident???? WHY DID NOBODY EXPLAIN THE FACT THAT PMBS ARE EXCLUDED AND WHAT THAT MEANT to me? I would not have accepted the exclusion. To date nobody at Key Health has accepted responsibility for not explaining this to me.

I am utterly disappointed with Key Health and the manner in which they have dismissed me every time I request them to reconsider.