Genesis denying us urgent PMB cancer treatment for my father

Genesis denying us urgent PMB cancer treatment for my father

I am writing this as the daughter of a Genesis Medical Scheme member who has been diagnosed with a Prescribed Minimum Benefit (PMB) cancer condition requiring urgent chemotherapy and radiation treatment. We have been assured that with timely treatment my father should make a full recovery.

Despite the clear urgency of his condition, Genesis has:

• Refused to provide or accept an application for access to treatment for a PMB at a private hospital • Ignored multiple emails and follow-ups • Provided conflicting and evasive responses • Insisted that my father must pay privately for treatment, even though PMB law clearly protects him.

Most disturbingly, Genesis has ignored a formal letter from the treating doctor at Chris Hani Baragwanath Hospital, which states:

“The oncology department is overwhelmed with a high burden of patients and the acceptable delay for his treatment will be exceeded. The patient does have medical insurance. This is a very clearly prescribed minimum benefit and it is therefore the duty and the responsibility of the medical insurance scheme to cover the cost and this should be done in the private sector.”

Despite this, Genesis continues to delay any meaningful response. The Assistant Manager – Oncology has either ignored our emails or responded without answering direct questions, seemingly intent on stalling the process. At this point, it feels like they are hoping my father’s condition deteriorates before they are forced to act.

To make matters worse, my father has even managed to secure treatment at Netcare Linksfield Clinic at the same rates charged by Chris Hani Baragwanath Hospital, meaning there would be no cost impact to Genesis – and yet they still refuse to authorise treatment.

This is not just poor service, it’s a shocking failure of duty, ethics, and compassion. Genesis is knowingly denying (or at the very least delaying) access to life-saving treatment, despite clear medical advice and the provisions of Regulation 8(3) of the Medical Schemes Act, which requires schemes to cover PMB treatment in full when DSPs are unavailable or cause unreasonable delay. What makes this even more outrageous is that Genesis has previously been taken to court over this exact issue and lost. The Constitutional Court dismissed Genesis’s appeal, confirming that medical schemes cannot use their rules to override the law. We are escalating this matter to the Council for Medical Schemes (CMS). Their treatment of our family during this crisis has been nothing short of disgraceful.

Genesis, your members are not just policy numbers. They are people - parents, grandparents, and loved ones - who deserve timely care and dignity. How many times to you need to be taken to court before you accept your legal responsibilities?