Council knocks Keyhealth over refusal to pay for PMB condition
Medical scheme denies prescribed minimum benefits for overactive thyroid, saying the member needs to develop a ‘thyroid storm’ before qualifying
The Council for Medical Schemes (CMS) says it’s “concerning” that Keyhealth medical scheme denied a member prescribed minimum benefits (PMBs) for an overactive thyroid on the basis that she needed to develop a “thyroid storm”, which is a medical emergency, before she could qualify for PMBs. Hyperthyroidism is a PMB condition, the council says. “This patient’s condition cannot validly be considered not to be a PMB just because her life is not in immediate danger,” the council’s clinical review committee says in a ruling against Keyhealth handed down earlier this year. The ruling stems from a complaint lodged by healthcare rights activist Angela Drescher on behalf of a member who Drescher says was treated unfairly by Keyhealth. The scheme at first rejected the member’s claims, saying her condition was not a PMB condition and not covered in terms of her benefit option. The ruling says that in October 2018, the member consulted her doctor as she was experiencing severely itchy skin. Her...
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