SHORT PAYMENT OF PMB LEGISLATED CLAIM

ATT: Varsha Vala It is with desperation that I am reaching out to you. Patient was admitted to hospital Via the ER unit with confirmed PMB - RSV PCR Ampath lab 13-05-2026. This was submitted to the medical aid and short paid at scheme rates. We have provided detailed motivations. Under the SA law an emergency medical admission remains a PMB condition in its own right!! Clinically and legally under SA law J12.1 can be diagnosed without a chest x-ray as a chest x-ray is not a legal requirement to define pneumonia under the SA coding standards or the Council for Medical Schemes guidelines. I await your urgent response