MEDICAL AID REFUSE TO PAY FOR EMERGENCY PROCEDURE

They refuse to pay for an emergency procedure at Medi Clinic Vereeniging. Their excuse is that there was no more funds in my day to day benefits.

I was treated on the 25th of December 2017 at Medi Clinic Casualties for a deep cut on the side of my finger and urgently needed stitches. They paid the Medi Clinic account but refuse to pay for the doctor (ER Consultancy).

However, they are obliged by The Medical Scheme Act 131 of 1998, Regulation 7 to pay in full.........

""CHAPTER 3 CONTRIBUTIONS AND BENEFITS 7. Definitions.—For the purposes of this chapter— “designated service provider” means a health care provider or group of providers selected by the medical scheme concerned as the preferred provider or providers to provide to its members diagnosis, treatment and care in respect of one or more prescribed minimum benefit conditions; “emergency medical condition” means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person’s life in serious jeopardy; “prescribed minimum benefits” means the benefits contemplated in section 29 (1) "

Selfmed Medical Scheme was requested to respond in writing and give reason/s for ignoring this law. I await their response.