LETTER: All medical schemes should cover PMBs
Prescribed minimum benefits should not be negotiable with service providers and networks
Your article on the banning of excessive co-payments imposed by medical schemes is indeed good news for members (“Medical schemes regulator boosts patients’ rights to choose their pharmacy”, April 27).
The next thing that should be banned by the regulator is the practice of certain medical schemes finding loopholes round paying for prescribed minimum benefits. (PMBs). Medical aid schemes should be banned from getting service providers to enter into agreements with networks relating to the PMBs.
It is totally absurd that a service provider sitting on one side of a drywall in a partnership arrangement provides service to a patient and the medical aid scheme pays that claim, while a patient seeing the partner on the other side of the drywall has to bear the cost themselves because that partner doesn’t accept the medical scheme’s terms and didn’t sign the agreement with the medical scheme.
It needs to be compulsory for all PMBs to be covered and paid for by all medical schemes.
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