Why are you evading paying out PMB claims?

<p>I received the following response to my request to have an account re-submitted for processing as some of the claims fall under the Managed Care Funding Protocol for my husband’s PMB (chronic) conditions: </p> <p> </p> <p>Dear Member<br /> <br /> Thank you for your email. Kindly be advised that the account treatment date 16/01/2017 for Dr Dietrich Bruce E Street & Partners was processed and paid correctly from your day to day benefit. It will first pay from your day to day than when your day to day is depleted than only will it pay from PMB.</p> <p> </p> <p><br /> <br /> This cannot be correct! You have always paid PMB – why should I use my day to day benefits for PMB? Then I might as well move to the lowest plan where there are no day-to-day benefits, and you will have to pay the approved PMB claims! At least 3 of the pathology codes are on the Managed Care Funding protocol that we received (4032, 4057, 4064).</p> <p> </p> <p>I then receive answers from the complaints department saying the claim will be re-processed. And then: all that happens is the claim is re-processed - nothing paid from PMB with the code: this account has already been processed!</p> <p>Why are you not paying the PMB claims? You are evading paying them. This is *******! All the ICD codes are correct!</p>