Abuse of medical benefits

<p>Here we go again.</p> <p> </p> <p>Bonitas has introduced another brilliant idea. Before you can see a specialist you need to have a GP referral. Please advise how you can generalise this rule.</p> <p> </p> <p>My daughter was born with a con******* heart defect she is 2 year 1 month now. This condition is currently being monitored by a paediatrician and a paediatric cardiologist. Now the scheme wants a GP referral to see these specialist. </p> <p> </p> <p>Just for the hell of it I used my benefit going to a GP on the network yesterday. The GP exact words ' We do not monitor heart failure in children as we do not know which signs to look out for it would be better for your paediatrian to monitor the condition'.</p> <p> </p> <p>Call the scheme this morning. They will accept the referral letter to the paediatrian but after 6 month would need to go back to the GP to get another referral letter. The GP will then have to do another referral for the cardiologist if she needs to see him. The GP confirmed again he would not be able to write the referral. My daughter visits the paediatrician every 3months to monitor there is no heart failure and a yearly visit with the cardiologist to view the heart echo. This year was different as she would not allow the echo to be done. </p> <p> </p> <p>Please explain why i need this referral if you the (scheme) has all my daughters’ medical history. Why is the scheme wanting the members to exhaust their benefit unnecessarily. I understand if there was no condition then fine, but when a condition is involved the rule should be exempted. The only time you exempt the rule is if the care plan has consults. How stupid is the care plan to be active in the beginning of the year when you have all you benefits and do not need the additional consults. The care plan should only come in to effect when the benefits have been exhausted and then paid from the risk pool.</p> <p> </p> <p>To sum all the frustration. The scheme wants your benefits to last but you need to use the benefit for unnecessary consults. The care plan: using 1st your day to day in the beginning of the year. This in turn using the additional benefit that has been provided even though the member is paying for the treatment.</p> <p> </p> <p>Would also love to know how the council of medical schemes approved this new rule.</p> <p> </p> <p>Regards</p> <p>Wayne</p>