Genesis Medical Scheme Complaints - Not paying for PMB

On 29 June 2018, Kelvin Van Baalen was paragliding in a competition in Barberton, in the Mpumalanga province of South Africa, one of many competitions he has participated in, in the past. On his last flight, the conditions weren’t good. He was coming in to land, saw the power lines at the very last minute, turned his wing too hard and spun straight into the lines. He felt a power surge and then was knocked unconscious. He awoke to find himself engulfed in flames.

Kelvin was airlifted to the Milpark Netcare Hospital and on arrival had 67% full thickness burns.

The following are my concerns with regards to how Genesis are handling Kelvin's case:

After 413 days in Netcare Burns ICU Kelvin was finally strong enough to be discharged and was admitted to the NetCare Rehabilitation Hospital.

On Saturday the 17th August 2019 it came to my attention that Genesis, in their words, "The scheme has reviewed the request and in light of the extensive injuries and accompanying co-mobilities the scheme will fund REHAB for 10 DAYS ONLY, this will be full and final funding."

10 days of rehabilitation for a man who has been in ICU for 413 days. I am devastated! disappointed! and heartbroken!

I want to put it on the record that this communication was never sent to me. It was sent to the Netcare Rehabilitation Hospital, who then sent it onto the Hero Burns Foundation, who then forwarded it to me. To date, Genesis have not contacted me directly in this regard.

It would appear, that due to his extensive injuries and accompanying co-mobilities, Genesis is refusing rehabilitation funding. I thought this was why we have Medical Aid? I didn't realize that Genesis could simply refuse to fund a treatment because it would cost too much? Why then do I have medical cover? Kelvin is on their top scheme. He is fully covered. And more than that, I thought burns is part of PMB? And is rehab not part of PMB?

To date Kelvin has had numerous skin grafts, his left anterior calf muscle had to be removed. During this period, he has suffered multiple organ failures due to infections. He has been resuscitated 9 times, dialysised on numerous occasions, ventilated and fed via a NG tube. He has super stiff joints in his legs and calcification of his major organs has occurred.

Kelvins case is highly complex and requires a multidisciplinary team of highly skilled professionals to work with him. Genesis have been advised of all this by the team of doctors, and yet, 10 days is all they are willing to fund.

He is unable to walk, feed himself, hold a phone, read a magazine, button his shirt, brush his teeth, and the medical aid is only willing to pay for 10 days of rehab.

Genesis haven't even deemed it necessary to find the time to go and access Kelvin, deciding on this life affecting, detrimental decision in a cold detached manner.

Kelvin was moved to rehab on Friday the 16th August, still on his NG feed, oxygen, with a catheter as he has no bladder or bowl control.

I am absolutely devastated and after Kelvin has fought so hard for so long it absolutely breaks my heart to imagine my son having to face the normal challenges of life after having received only 10 days rehab.

Kelvin is a miracle. He is a testament to the care he received from the team of dedicated staff and team of doctors at BICU. Genesis has invested a huge amount of money in Kelvin, I find it unbelievable that they would not help him cross the finish line. He could be a testament to them as well. It can be equated to been given a beautiful car with no tires, it just makes no sense.

Kelvin is an extraordinary child, even before the accident, and more so now! He is the youngest up and coming paragliding pilot in the country, having flown distances no one has matched, not even those with 30 years flying experience. He has won many competitions.

In primary school he played cricket for the junior Gauteng Cricket Team. He is a scratch golfer, an A league squash player and a student who was going to study law. Kelvin still wants these things and is fighting to be able to live as normal life as his injuries will allow. I'm devastated that Genesis is not fighting for him as well. How can they just drop him at the finish line? Do they not want to celebrate in his success? Do they not realize the miracle before them? He is 22 years old. He has his whole life ahead of him.

I have been advised that all the doctors from Kelvin's medical team have sent letters of motivation to Genesis, explaining his situation yet Genesis has simply decided, in advance, that they will only pay for 10 days rehab.

I am heartbroken and terrified at the possible consequences to Kelvin, all due to the decision which has been made.

This is my child, my miracle.

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