Genesis will pay — for now — in dispute over rehab as a PMB

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The Genesis Medical Scheme has agreed to authorise and pay the rehabilitation costs of burn survivor Kelvin van Baalen pending the outcome of a complaint that these costs should be covered by the scheme as a prescribed minimum benefit, reports Business Day.

The scheme had refused to pay for more than 10 days of rehabilitation but the agreement, made an order of court, came after van Baalen lodged an urgent application to the Western Cape High Court asking it to order the scheme to pay for his treatment, pending the outcome of a complaint laid with the Council for Medical Schemes.

He alleges in the application and in his complaint that he was entitled to the treatment as it is covered as a prescribed minimum benefit. Genesis has agreed to authorise the treatment and pay the costs in the interim on condition that the benefit is repaid if the complaint to the council is resolved in the scheme’s favour.

According to the report, van Baalen was severely burnt after paragliding into electricity lines and after being resuscitated nine times and spending 413 days in intensive care, he was considered ready to leave hospital in September to begin a lengthy rehabilitation programme. The scheme paid more than R15m for his hospital treatment, but only approved 10 days in a rehabilitation facility when his medical team had recommended 12 weeks.

Business Day report

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