1 reviews | Active since Nov 2013
Disappointed in Discovery Health
I have a damaged neck and have undergone three surgeries. Discovery are are fully aware of my pre-existing condition. My neck has been particularly painful for the past six months and in December 2014 I consulted Dr Mike du Trevou who referred me to Dr S T Govender, both of whom are neurosurgeons. Dr Govender suggested that I undergo a Rhizotomy that involves a day in hospital as it is performed in the theatre under general anaesthetic. Dr Govender told me that Discovery have a protocol that before having the Rhizotomy, one must undergo a facet block which cost would mostly be from my own pocket, not my MSA! The third person at Discovery suggested that I send a letter of motivation from the Dr which might allow me to have the procedure. I did that but Discovery have declined both procedures with a explanation about protocols. I was also warned that should I go ahead with the Rhizotomy, I would be responsible for the whole cost as they wouldn't even pay for the hospital. Dr Govender admitted me to hospital for pain control for two days and Discovery covered it which I find quite ironic. I really need to have this procedure as I'm constant pain and have referred this to the Ombudsman
Thank you for your comment.
Our role is to ensure members of the Scheme have access to quality healthcare in a way that remains affordable and sustainable. Some of the ways we achieve this is in our plan and benefit design and the application of funding policies and clinical protocols. We recognise that your doctor is in the best position to make medical decisions about your condition and treatment. In declining the funding for your procedure, we have not questioned the diagnosis or the treatment the doctor recommended. As a healthcare funder, we decide about funding treatments to make sure the medical scheme can pay claims now and in the future.
I investigated your query and confirmed that based on the information we have received the funding decision communicated to you will not change. We confirmed that you raised the query with the Council for Medical Schemes who will be providing you with feedback.
I am sorry I could not provide you with a different outcome to your query.
Kind regards
Jashvir
Thank you for your comment.
Our role is to ensure members of the Scheme have access to quality healthcare in a way that remains affordable and sustainable. Some of the ways we achieve this is in our plan and benefit design and the application of funding policies and clinical protocols. We recognise that your doctor is in the best position to make medical decisions about your condition and treatment. In declining the funding for your procedure, we have not questioned the diagnosis or the treatment the doctor recommended. As a healthcare funder, we decide about funding treatments to make sure the medical scheme can pay claims now and in the future.
I investigated your query and confirmed that based on the information we have received the funding decision communicated to you will not change. We confirmed that you raised the query with the Council for Medical Schemes who will be providing you with feedback.
I am sorry I could not provide you with a different outcome to your query.
Kind regards
Jashvir
