ER
Eunele R

1 reviews | Active since Mar 2025

13 Mar 2025, 01:42

Disgusted and furious client.

A week and a day ago, I got a call from my son's school telling me he had an accident and it seems like he dislocated his collar bone, once I picked him up at school we went straight to our network GP, who then sent us for x-rays, once the x-rays was done it was discovered that he had a mid sharft clavicle fracture (displacement). My GP immediately sent us to see the Orthopaedic surgeon for advice, he then notified us that my son will need to have a plate put in to aline the two one together as they were laying on top of each other. The Wednesday morning I requested for authorization from Dis-Chem medical insurance, they delayed the requested by asking for different documentation each and everyday, and each and everyday the surgery was postponed doctors notes where sent xray reports were sent, specialist motivational letter was sent, my specialist even sent another letter and yet they declined. 1st it was because i didnt take him to the emergency room, then it was my medical was suspended (which was billings fault) then it was tbe clinical team will review this case ,I then got an email declining the authorization, as 1 its not a life threatening injury, 2 because it was not done immediatly 3 because they dont cover PMB's. But before this formal denial they gave me different reasons to why the cant authorize it. I escatated this and after 2 days i am yet to get an reply. Tonight my son had a secondary injury to the same shoulder as his cousin ran into him by accident( kids will be kids), this time I followed the steps, to take him to the emergency room as I knew that the fracture was still new and any more impact could cause more damage to the fracture. The ER doctor requested he says over night to see the specialist as the he was a bit concern to how the fracture has grown. Dischem medical insurance declined the emergency consult as well as the request for hospitalization as it was an old injury. Yes an old injury that was re-injured due to them. My son has to suffer as he is in pain and living in a sling as it can not be removed till that bone has fully healed and as we saw tonight it will not happen. He can't write as it's his right arm, he want play sports and he can't be a normal child. He is bound to his bed and room as we are scared to cause and more damage. Every month Dischem medical insurance is eager to debit my acc but when it comes to situations like this emergencies, the main reason we have this insurance they refuse to pay for anything. I am disgusted and I will not be leaving this matter at this, I will be taking this further.

0
Replies (1)
Dis-Chem Health (Medical Insurance & Gap Cover)
Dis-Chem Health (Medical Insurance & Gap Cover)'s reply13 Mar 2025, 10:32
Official
 
We're sorry to hear about your experience, Eunele. We understand how frustrating this may have been. We assure you that we have taken the necessary steps to resolve this matter, and we will be in contact as soon as possible.