Scan approved, then declined.

I requested authorisation for a fe full body scan. I was first told it was not covered but then told it is covered provided that the specialist send a referral letter and well as a letter of motivation. ***

Yesterday I received an authorisation number for the scan, scheduled for 18 September: ***. I have consequently put in leave for that day.

This morning I received another email from Momentum that the scan has been declined. ***

After phoning Momentum and informing them that the scan was approved and then declined they DELETED the approved authorisation. I though this might happen so I printed out the authorisation.

According to the council for medical schemes the scan should be 100% covered if the scan is clinically required to diagnose, treat, or monitor a registered PMB condition. The purpose of the scan is to DIAGNOSE a possible disease as multiple joints are affected and the doctors are trying to determine the reason for this. Multiple joint pain can be a primary symptom of several underlying diseases that are legally protected under the Council for Medical Schemes (CMS) guidelines.

My clinical history (available to Momentum) confirms that the scan is a prerequisite for a PMB treatment plan.

I find it unacceptable for a medical aid to approve a procedure and 24 hours later decline it. Then you have to audacity to delete the authorisation and tell me to have it done and pay for it myself before you MIGHT consider paying for it!

I will without a doubt report this to the CMS.