Friday, August 12, 2022
HomeWeekly RoundupCMS takes Keyhealth to task for not paying out for PMBs

CMS takes Keyhealth to task for not paying out for PMBs

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.

[link url=""]Business Day report[/link]

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