NCR: Discovery Health and ICD-10 Codes

[Frosty]

One person's complaints is another's compliments...

When I was on Fedhealth I had lots of problems with their claims department. Now that've I've been on Discovery for 2 weeks short of 7 years I've never had a single problem, not even with the ICD-10 codes.

 

@ markStockton: Thanks for your original post (list of codes) - sure to come in handy soon.

 

[Gatiepie]

porky, Coronary artery disease is a Chronic PMB (Prescribed Minimum Benefit) condition and therefor the medical aid HAS to pay for the treatment even if it is not on their list of medication and even if the patients MSA has been depleted. According to PMB they have to pay for the same care the patient would have received in public. So, if the public hospital would have treated the patient and prescribed that medicine, the medical aid has to pay it. Medical aids prefer to ignore most of the items in the PMB and hope that the doctors and patients will just ignore it and pay for these items cash. If you require ANY help with these claims, contact SpesNet at 0126739262 I think. I don't know if they will charge you to assist but doctors that are members will get the advice for free. They specialize in claims from Medical Aids and correct billing and coding from doctors. You can PM me if you need some more info but most of it can be found at http://www.bhfglobal.com/prescribed-minimum-benefits. Check the bottom links for the FAQ as it makes for very interesting reading. To get back to the Medical Aids' lack of paying, as long as the coding is correct, they don't have a foot to stand on, but too many doctors ignore the coding standards so the Medical Aids will reject claims left right and center based on mistakes from the pharmacists and doctors. I agree that medical aids are a bunch of you name it whats, but when you know the law and their procedures, you can make them pay for your broken collar bone sustained during a professional cycle race. The beauty is that they are well regulated, but they bargain on our ignorance of the regulations.