1 reviews | Active since Apr 2015
Chronic Application for Asthma
My husband has suffered with asthma since birth. He has been on all medication, including preventatives, and found one specific pump that works. After waiting his 12 month waiting period, app**** for Chronic Medication. The berotec pump that works was approved with only R30-00 being covered by chronic. We thought we would then try all the meds on their list. With side effects ranging from insomnia, loss of appetite, nausea etc, and after landing up in hospital last year May we decided to try cover his berotec in full. We submitted the paper work again, again they only approved R30-00 of the pump. The strange thing is that the other meds that he tried were costly, incl delivery costs etc. The berotec pump is at most R180-00. I then called the call centre and they told me that the doc needs to fill in an appeals form, which we did. Same response. Reason being,that there was not enough motivation from the doctor. Our doc then wrote a motivation letter and once again same response that not enough infomation was on the letter. They wanted the doctor to state why the meds weren't working. Forgetting that their call centre told me decisions were not made by doctors.
Thank you for your comment.
The Chronic Illness Benefit (CIB) covers 27 conditions on all plans as prescribed by legislation. The same legislation permits schemes to compile lists of medications called formularies, which complies with guidelines issued by the Council for Medical Schemes. Medicines on the list are safe, clinically appropriate and cost-effective for the treatment of the specified conditions. To ensure cover in full, medicines on the scheme's formulary should be used.
I confirmed that the medication requested to be funded in full is not on the formulary and based on the information received the entry criteria was not met. As discussed you may send any further clinical information directly to me so I may facilitate the process further.
Thank you for allowing me to assist with your query and I am sorry I could not provide you with a different outcome.
Kind regards
Jashvir
Thank you for your comment.
The Chronic Illness Benefit (CIB) covers 27 conditions on all plans as prescribed by legislation. The same legislation permits schemes to compile lists of medications called formularies, which complies with guidelines issued by the Council for Medical Schemes. Medicines on the list are safe, clinically appropriate and cost-effective for the treatment of the specified conditions. To ensure cover in full, medicines on the scheme's formulary should be used.
I confirmed that the medication requested to be funded in full is not on the formulary and based on the information received the entry criteria was not met. As discussed you may send any further clinical information directly to me so I may facilitate the process further.
Thank you for allowing me to assist with your query and I am sorry I could not provide you with a different outcome.
Kind regards
Jashvir