Disappointed, fatigued and fed up

Unfortunately I am quite disappointed by Discovery Health refusing to pay for an iron infusion. I was on oral therapy for 7 months (which I paid). I then received 500mg iron IV at my GP's practice (which I paid). I paid all my blood tests and co-payments to the doctor. After all of this, my Ferritin levels only moved from a 3 to 20 (iron storage levels). This is WAY below the healthy level. I went to see a Haematologist (for which Discovery Health again did not pay). By recommendation of the Haematologist, I need additional iron infusions because of my low Ferritin levels and how it affects my quality of life. I also need to see a Gynaecologist and I assume Discovery will likely also not pay for this. Please please please help me out here Discovery Health.

Discovery rep**** via email with the below (when I requested that they fund my iron infusion):

We will not pay for the Monofer

We received the details of your planned treatment. Unfortunately, the clinical information about your condition does not meet our criteria for payment so we have declined the funding request.

We try to make consistent and fair payment decisions in the interest of all our members

We recognise that the treating doctor is in the best position to make medical decisions about your condition and treatment. When we made this decision, we did not question the diagnosis or the treatment the doctor recommended.

As a healthcare funder, we decide on paying for treatment in such a way that we make sure Discovery Health Medical Scheme can cover claims now and in the future. We have a responsibility to make sure members of the Scheme have access to quality healthcare in a way that stays affordable and sustainable.

Some of the ways we achieve this is:

In our plan and benefit design By creating and applying payment policies and clinical protocols that we have developed using a rigorous, evidence-based decision-making process. This process also helps us to decide which procedures and treatment to exclude from cover. We hope this explains our reasons for declining your payment request.

To find out more about your cover and benefits, visit www.discovery.co.za

Regards

Sue Ramlakhan Discovery Health (Pty) Ltd On behalf of Discovery Health Medical Scheme