REFUSE TO PAY PMB CONDITION

6 FEB 2015 it was an emergency admission, I had a stomach obstruction & bleeding ulcers. I was transferred to Little Co of Mary (Pta) as Faerie Glen Hosp didnt have a Spec working at this hosp, I paid R850. <br> My Specialist Dr Bezuidenhout's ICD 10 Codes were correct, he confirmed its a PMB CONDITION, also sent letter to Momentum.<br> The Medical Schemes Act No 131 of 1998 states that Med Schemes must cover ALL COSTS related to the <br> diagnosis, treatment, care costs. They have to cover the full costs REGARDLESS OF YOUR CHOSEN MED <br> SCHEME PLAN OPTION subject to managed care tools <br> i.e. treatment exclusions, limits on specific benefits, <br> place of service, general exclusions. Momentum refuses to accept this PMB COND of mine(but they aurhorized another gastroscopy). Kelly said 31/3 aneathetist & medicine for this diagnosis is not covered om my Optionplan ! They refuse to reimburse me for all the medication for my treatment of PMB Cond, I paid at Chemists, ALSO refuse to refund R850, emergency & medicine R305, I pd while in Hosp. I claim all of above mentioned refunds & they MUST REGISTER this diagnosis as PMB COND on their System pls. I'm scheduled for another gastroscopy, have scripts etc