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Med scheme covers chemo treatment but not weekly Covid test required by hospital

24 February 2021 7:39 PM
Tags:
The Money Show
Bruce Whitfield
Medical aid
Wendy Knowler
chemotherapy
medical claims
Momentum
medical schemes
COVID-19
Covid-19 testing
consumer issues
Momentum Health
hospital costs

Consumer ninja Wendy Knowler follows up on the case of a patient who'd been paying his membership dues for more than 40 years.

A 73-year-old Durban man has had a particularly rough ride undergoing chemo treatment during the Covid-19 pandemic.

Keith and his wife have been members of Momentum Health (previously National Medical Plan) for 40+ years and say they hadn't claimed much until he was diagnosed with a form of cancer four years ago.

From September last year Keith had to undergo weekly chemotherapy, covered under a code which should pay for anything to do with his cancer treatment.

RELATED: Medical aids must now pay for Covid-19 tests under new regulations

However, Momentum baulked at covering the cost of the Covid blood test required each time he entered the hospital.

Over the course of six months, this would amount to around R15,000.

But I’m being told, tough luck, even though a Letter of Motivation has been sent to the Medical Aid from the haematologist explaining it should be covered under his C90 cancer code.

Wife of cancer patient

Only after consumer ninja Wendy Knowler followed up did Momentum agree to cover the cost of the tests performed so far.

As the health care industry adapts to the pandemic scenario "there will be instances like this where we come across a process that needs to be revisited and refined” it said.

Knowler questions the following statement from Momentum:

"We would also like to point out that the results of a Covid-19 test conducted weekly would not be accurate (as the test is done almost every 5 days)."

So did they decide not to cover the tests because they doubted the accuracy of the results? How does that support the member who's been told: you have the test, or you don't have the chemo!

Wendy Knowler, Consumer journalist

Knowler has asked for more clarity from Momentum.

For more detail on the case, take a listen:




24 February 2021 7:39 PM
Tags:
The Money Show
Bruce Whitfield
Medical aid
Wendy Knowler
chemotherapy
medical claims
Momentum
medical schemes
COVID-19
Covid-19 testing
consumer issues
Momentum Health
hospital costs

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