CMS takes Keyhealth to task for not paying out for PMBs

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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.

Business Day reports that 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.

After the complaint was lodged with the council, Keyhealth conceded that it had been incorrect and that hyperthyroidism was a PMB, the ruling says.

Business Day report

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