Momentum Medical Aid Refuses to Cover Emergency C-Section Despite PMB Regulations

On 7 August 2025, my wife was admitted for an emergency c-section due to fetal distress, on the advice of our gynecologist. This procedure is clearly classified as a Prescribed Minimum Benefit (PMB) under South African medical aid regulations and should be covered in full by our medical aid provider, Momentum.

Despite this, Momentum has refused to pay more than the scheme rate to both the Gynecologist and the anesthetitist who performed the emergency proceduure, which covers only about 25% of the total bill. Their reasoning? They claim this was a pre-booked event. This is factually incorrect. The original due date was 17 August 2025, as per the authorisation form we submitted. The emergency procedure occurred ten days earlier, and only because of a sudden and medically necessary decision made by our gynecologist.

Momentum’s refusal to pay is not only *********, but also in direct violation of PMB regulations. Our gynecologist—who is not a designated service provider, which we knew at the time—has provided TWO formal letter explaining the emergency nature of the procedure, yet Momentum continues to ignore this and deny full payment. Momentum's feedback states "We are not disputing the emergency nature of the delivery; we are basing the decision on the fact that the member voluntarily utilized a non-designated service provider.". They even acknowledge that it was an emergency and should therefore qualify for PMB.

Momentum clearly states on its product brochures that there would be a 30% co-payment that we were liable for, however it seems that they are misleading the public with FALSE advertising and hide terms and conditions deep into their policy wording.

This has placed an enormous financial and emotional burden on our family during what should have been a time of celebration. Momentum’s handling of this situation has been disgraceful, and I am calling on them to honour their legal obligations and do what is right.

I urge others to be cautious when considering Momentum as a medical aid provider. When we needed them most, they failed us. I would not recommend them at all.