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'Misunderstanding' lands TB sufferer in trouble

By unknown | Nov 12, 2008 | COMMENTS [ 0 ]

Changing medical aids can be unhealthy - especially if you don't have to.

Changing medical aids can be unhealthy - especially if you don't have to.

Pauline Makote changed hers after Momentum told her about the benefits she would acquire if she became one of its members.

After becoming a member she received a list of doctors and private hospitals that deal with Momentum medical aid members. A month later she became ill, was diagnosed with flu and booked off for two days.

Her health deteriorated though she was treated.

"On consulting one of the listed doctors I was diagnosed with pneumonia and referred to Krugersdorp Hospital. I was admitted to hospital and six days later I was told that I had TB," she said.

Momentum declined her claim on the grounds of her not having disclosed that she was suffering from TB .

"I did not have this sickness before I took out membership and my medical history from my family doctor was forwarded to them when I took up membership," she said.

Momentum refused to pay her claim of R33048 and only reviewed its decision when Consumer line stepped in.

Nomusa Sithole of Momentum's fund management department said there was a misunderstanding in Makote's case.

She said Momentum began an investigation into the possible non-disclosure of material information after receiving clinical history reports from Dr JL Voster (a general practitioner from Primecure) and Dr H Vermooten (a specialist), which both stated that there were two consultations on 13 and 20 September 2008 for tuberculosis (TB).

The member did not disclose TB on application because this was a new diagnosis.

"After thorough investigations the scheme realised that there was no evidence of non-disclosure in this case," Sithole said.

She said Momentum medical aid would settle the hospital accounts.


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