pG
pieter G

1 reviews | Active since Apr 2012

28 Feb 2024, 15:21

Attempt to draw Mr Adrian's Gore attention to issues with Discovery Chronic devision

Discovery got an excellent business model but getting more and more beneficial for the effluent and wealthy. The wealthy get more value from all the add-ons (Cheap flights, fuel, gym holidays, etc) cross subsidised by the average person’s medical aid premiums. Discovery’s chronic division is an absolute nightmare to deal with, my own health is suffering due to continue challenges with them. My wife had a stroke in November 2022 and it took until 8 Sept 2023 to get funding approved for treatment as a Prescribed Minimum Benefit (PMB). This is now after mediation by CMS. So, after this stressful period just to receive another letter on 19 December 2023 informing us that benefit is suspended after a year. The specialist renewed motivation for same medication on 20 February 2024 and case is now referred for an appeal hearing on 26 March 2024. Discovery having their lawyers representing them, I was informed I can contract in specialists, lawyers etc at my own costs. WOW!!! Below copy of relevant sections of letter dated 8 September 2023 “Please note: This authorisation has been approved as ongoing. All items marked with an * will be replenished on a yearly basis and Mev Maria will not need to reapply for these benefits .” See below items marked with * 31 Des 9999* and note above that items marked with * will be replenished on a yearly basis and Mev Maria will not need to reapply for these benefits

Follow up Clopidogrel 75 biotech 30 per This benefit has been 18 Dec 2022 Medication Follow up Medication *** Xarelto *** . Month For approved as it is Clinically '12 : appropriate for the request. Ii Month(s) •' : 30 per ! This medicine is not on the. I : Month For medicine list (formulary). We 113 ! will pay for it up to the: Month(s) lmonthly The****utic: Reference Price. to 31 Dec 9999* 21 Apr 2023 1 to 31 Dec 9999*

0
Replies (4)
Discovery Health
Discovery Health's reply29 Feb 2024, 06:56
Official
Dear Pieter G

We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible. 
   
Regards 
Discovery Health Servicing Team
Discovery Health
Discovery Health's reply05 Mar 2024, 08:29
Official
Dear Pieter G

We have been in touch with you to answer your comments.

Regards
Discovery Health Servicing Team
 
pG
pieter G's update05 Mar 2024, 10:26
Reviewer Update
Yes, been in contact with me. Been informed of review decision. However Clovexa tablets been removed from cover with no justification. I wrote a new complaint letter to them.
Discovery Health
Discovery Health's reply25 Mar 2024, 16:57
Official
Dear Pieter G

We have been in touch with you to answer your comments.

Regards
Discovery Health Servicing Team