EL
Etienne L
1 reviews | Active since Dec 2014
03 Mar 2016, 16:19
Transmed refusing to pay
My mom is on the most expensive Transmed option (Private Network). She needs to undergo a total hip replacement in the Netcare Greenaces hospital which qualifies as one of the hospitals in the Private Network. Transmed is refusing to pay a SINGLE CENT for the operation. My question is, what is the point of paying R3000+ each month if they cannot pay for an operation when needed? What then is the difference between the Private Network option and the other options? I refuse to leave this here. My mom has been loyal to Transmed for nearly 40 years and they cannot even pay at least a percentage of the cost for a single operation.
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Transmed's replyOfficial
07 Mar 2016, 09:23Hello AnonymousZA,
In October 2012, due to the demographic changes (age and health), the Fund were forced to make changes to the benefits for the then Private Network Saver benefit plan. These changes were necessary to keep the benefit plan sustainable. One of the changes that was implemented was to only fund Prescribed Minimum Benefits (PMB).
The operation required by your mother is a non-PMB condition and not covered within the benefit structure of the chosen plan. We have referred the case to the Medical Advisor for review and input. With the information available there no clinical merit to reclassify the condition as PMB and will therefore not be funded by Transmed.
Your mother can apply for financial assistance through the Ex-gratia committee and an application form is available on the Transmed webpage at www.transmed.co.za. An application through Ex-gratia should under no circumstance be regarded as a guarantee for financial assistance.
Kind regards
The Transmed Team
In October 2012, due to the demographic changes (age and health), the Fund were forced to make changes to the benefits for the then Private Network Saver benefit plan. These changes were necessary to keep the benefit plan sustainable. One of the changes that was implemented was to only fund Prescribed Minimum Benefits (PMB).
The operation required by your mother is a non-PMB condition and not covered within the benefit structure of the chosen plan. We have referred the case to the Medical Advisor for review and input. With the information available there no clinical merit to reclassify the condition as PMB and will therefore not be funded by Transmed.
Your mother can apply for financial assistance through the Ex-gratia committee and an application form is available on the Transmed webpage at www.transmed.co.za. An application through Ex-gratia should under no circumstance be regarded as a guarantee for financial assistance.
Kind regards
The Transmed Team
Best regards,
Transmed's reply07 Mar 2016, 09:23
Official
Hello AnonymousZA,
In October 2012, due to the demographic changes (age and health), the Fund were forced to make changes to the benefits for the then Private Network Saver benefit plan. These changes were necessary to keep the benefit plan sustainable. One of the changes that was implemented was to only fund Prescribed Minimum Benefits (PMB).
The operation required by your mother is a non-PMB condition and not covered within the benefit structure of the chosen plan. We have referred the case to the Medical Advisor for review and input. With the information available there no clinical merit to reclassify the condition as PMB and will therefore not be funded by Transmed.
Your mother can apply for financial assistance through the Ex-gratia committee and an application form is available on the Transmed webpage at www.transmed.co.za. An application through Ex-gratia should under no circumstance be regarded as a guarantee for financial assistance.
Kind regards
The Transmed Team
In October 2012, due to the demographic changes (age and health), the Fund were forced to make changes to the benefits for the then Private Network Saver benefit plan. These changes were necessary to keep the benefit plan sustainable. One of the changes that was implemented was to only fund Prescribed Minimum Benefits (PMB).
The operation required by your mother is a non-PMB condition and not covered within the benefit structure of the chosen plan. We have referred the case to the Medical Advisor for review and input. With the information available there no clinical merit to reclassify the condition as PMB and will therefore not be funded by Transmed.
Your mother can apply for financial assistance through the Ex-gratia committee and an application form is available on the Transmed webpage at www.transmed.co.za. An application through Ex-gratia should under no circumstance be regarded as a guarantee for financial assistance.
Kind regards
The Transmed Team
Best regards,