SP
Sandra P
1 reviews | Active since Feb 2015
17 Jun 2022, 13:06
Unreasonable approval process
EF du Plessis - ***
The member is at end stage Parkinsons, she has trouble swallowing and asperates when eating and drinking fluids. This may result in Pneumonia or in death. As an alternative she has been on feeds since 2017. Now after 5 years, Bankmed is insisting on only approving benefits for 3 months, where after a progress report must again be submitted by the Dietician. There will never be progress , as her condition will only worsen. She cannot stand up on her own and also cannot walk anymore, she also has Parkinsons Dimentia. They refuse to provide a reasonable explanation for this sudden decision. The only deduction is that they either want to starve her death or have her bedridden in a hospital dying of pneumonia.
Thank you Esmè le Grange and the Bankmed Review Team
Helpful (0)
Replies (6)0
Replies (6)
Bankmed's replyOfficial
17 Jun 2022, 14:03Hi Sandra, we sincerely apologize for this experience. We will investigate your concerns and reach out to you as soon as possible to assist. Regards.
Best regards,
Bankmed's reply17 Jun 2022, 14:03
Official
Hi Sandra, we sincerely apologize for this experience. We will investigate your concerns and reach out to you as soon as possible to assist. Regards.
Best regards,
Bankmed's replyOfficial
17 Jun 2022, 15:52Hi Sandra, we have reviewed your request for funding for Emmerentia Du Plessis and we can confirm that our Medical Review Team have approved the continuation of feeds as an exception. As you have been advised the funding decision is outside the member’s normal plan benefits and the approval was based on the condition and clinical appropriateness. Due to this we require a progress report/assessment every three months to determine the member’s progress. On receipt of the aforementioned, the report will be reviewed for continuation of benefits. We are sorry that we could not provide you with the answer you sought, however we assure you that we have explored all available channels. Regards.
Best regards,
Bankmed's reply17 Jun 2022, 15:52
Official
Hi Sandra, we have reviewed your request for funding for Emmerentia Du Plessis and we can confirm that our Medical Review Team have approved the continuation of feeds as an exception. As you have been advised the funding decision is outside the member’s normal plan benefits and the approval was based on the condition and clinical appropriateness. Due to this we require a progress report/assessment every three months to determine the member’s progress. On receipt of the aforementioned, the report will be reviewed for continuation of benefits. We are sorry that we could not provide you with the answer you sought, however we assure you that we have explored all available channels. Regards.
Best regards,
SP
Sandra P's updateReviewer Update
17 Jun 2022, 15:59As you are unable to provide valid reasons for this you keep it private and give platitudes for your reason for this.
SP
Sandra P's update17 Jun 2022, 15:59
Reviewer Update
As you are unable to provide valid reasons for this you keep it private and give platitudes for your reason for this.
SP
Sandra P's updateReviewer Update
17 Jun 2022, 16:02Further, you must take the necessary action to provide travel to the dietician and back home and pay the cost for travel and the assessment outside of her benefits as you insist on this as a condition. I cannot take off from work every time you require assessments.
SP
Sandra P's update17 Jun 2022, 16:02
Reviewer Update
Further, you must take the necessary action to provide travel to the dietician and back home and pay the cost for travel and the assessment outside of her benefits as you insist on this as a condition. I cannot take off from work every time you require assessments.
Bankmed's replyOfficial
17 Jun 2022, 16:41Hi Sandra, we understand that is not the outcome you sought however, the decision is within he Schemes guidelines and rules. We make consistent and fair funding decisions in the interest of all members of the Bankmed Medical Scheme. Our role is to ensure members of the Scheme have access to quality healthcare in a way that remains affordable and sustainable. Regards.
Best regards,
Bankmed's reply17 Jun 2022, 16:41
Official
Hi Sandra, we understand that is not the outcome you sought however, the decision is within he Schemes guidelines and rules. We make consistent and fair funding decisions in the interest of all members of the Bankmed Medical Scheme. Our role is to ensure members of the Scheme have access to quality healthcare in a way that remains affordable and sustainable. Regards.
Best regards,
SP
Sandra P's updateReviewer Update
19 Jun 2022, 21:44Please explain why this benefit was not an issue for 5 years and now must be reviewed, 3 monthly. You were provided with video evidence that she had trouble swallowing 5 years ago. With a progressive disease like Parkinson's and end stage Parkinson, please explain to me in medical terms how you perceive that there will be an improvement in her condition over a 3 month period. She asperates immediately when drinking fluids and can only chew a few bites before her swallowing becomes affected. She cannot remember not to put more food in her mouth if she has not swallowed first. WHAT WILL CHANGE IN 3 MONTHS. DO YOU HAVE A CURE II AM NOT AWARE OF
SP
Sandra P's update19 Jun 2022, 21:44
Reviewer Update
Please explain why this benefit was not an issue for 5 years and now must be reviewed, 3 monthly. You were provided with video evidence that she had trouble swallowing 5 years ago. With a progressive disease like Parkinson's and end stage Parkinson, please explain to me in medical terms how you perceive that there will be an improvement in her condition over a 3 month period. She asperates immediately when drinking fluids and can only chew a few bites before her swallowing becomes affected. She cannot remember not to put more food in her mouth if she has not swallowed first. WHAT WILL CHANGE IN 3 MONTHS. DO YOU HAVE A CURE II AM NOT AWARE OF