GH
Gary H

1 reviews | Active since May 2016

05 Sept 2021, 16:37

Discovery ignores the CMS ruling, regarding a PMB

I am very frustrated and disappointed, that Discovery will not get back to me regarding my daughters PMB condition, even after the Council of Medical Schemes (CMS) has ruled in my favour.

I have contacted Discovery Health on multiple occasions and they refuse to acknowledge the CMS ruling. I've tried contacting the principal officer and have been promised I will be contacted, this has been going on for months, with no email reply or anybody contacting me.

The CMS ref = CMS 76767 CMS ruling: "113S - Acquired haemolytic anaemias. The medical scheme denied funding for treatment and stated the member does not qualify for funding as the criteria has not been met. Such criteria have however not been specified by the medical scheme. The PMB criteria for 113S - Acquired haemolytic anaemias has been met and the beneficiary’s condition constitutes a PMB."

0
Replies (2)
Discovery Health
Discovery Health's reply06 Sept 2021, 07:16
Official
Dear Gary H
 
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 reply08 Sept 2021, 15:17
Official
Dear Gary H 
We have been in touch with you to answer your comments.

Regards
Discovery Health Servicing Team