Discovery Please allow my daughter to have a normal life.

<p>My membership with Discovery is: 49 ********** </p> <p>My daugter is 19 years of age, she has never ejoyed her childhood and her secondary school years because she can run she had to wear two bras to try and cover her breast she is wearing 36E, even though E bra does not cover her breast. she has headaches and continuos back pain. The advise that I got from GP years ago was to allow her to grow up and at 18 she will be fully developed that is when we can eliminate the problem through breast reduction before her back can be damaged further.</p> <p>I used this to support my daughter who was looking forward to turn 18 and get rid of the load that she carries 24/7. She was busy with her Matric she just completed and we went and cosulted with the GP and the specialist who confirm the urgent need for the breast reduction operation.</p> <p> </p> <p>i was under the impression that i have a medical aid insurance that will come handy when we are faced with this challenges. our specialist took photos and motivated our request with Discovery and this is what they said</p> <p> </p> <p>"</p> <p>Our funding decision for the hospital admission for bilateral breast reduction</p> <p>We have reviewed your request to cover bilateral breast reduction for Miss Mabotja to be done at Netcare Akasia Hospital on 27/01/2017.</p> <p>These are the details of your request</p> <p>Treating doctor<br />Dr K Segwapa<br />Requested codes<br />N62, 0339, 0008<br />We confirm that Miss Mabotja is on the Classic Priority Plan.</p> <p>We have declined funding for Miss Mabotja's bilateral breast reduction</p> <p>Bilateral breast reduction is listed as a general scheme exclusion in our Scheme rules. We have therefore declined your request for funding.</p> <p>If Miss Mabotja decides to go ahead with the treatment, she will have to cover all the costs related to this treatment, including the hospital admission, herself.</p> <p>We make consistent and fair funding decisions in the interest of all our Scheme members</p> <p>We recognise that the treating doctor is in the best position to make medical decisions about Miss Mabotja's condition and treatment. In reaching this decision we have not questioned the diagnosis or the treatment the doctor recommended. As a healthcare funder, we decide on funding treatment to make sure the Scheme can cover claims now and in the future.</p> <p>We have a responsibility to make sure members of the Scheme enjoy access to quality healthcare in a way that stays affordable and sustainable.</p> <p>Some of the ways we achieve this is in our plan and benefit design, the creation and application of funding policies and clinical protocols that are developed using a rigorous, evidence-based decision-making process. This process also helps us make decisions about which procedures and treatment to exclude from cover.</p> <p>We hope this clarifies the reasons for declining your funding request."</p> <p> </p> <p>To my suprise Discovery approve breast reduction for other pattients why could they not approve for my daughter do they approve request from specific doctor or specific members i will like to know that.</p> <p>My doctor tried everything in his power to convience Discovery that my daughter needs this but they refuse to help.</p> <p>I called Discovery Call centre on the 23rd just fter 15:00 requesting to speak to the Medical advisor I was told that I cant speak to the medical advisor they can only put me through to the Medical advisor call centre that will give me a clinical advise that will not replace my Doctors advise.</p> <p> </p> <p>I waited until I was cut off, Discovery refused to permitt me to speak to their Medical advisor because I wanted to ask him the following questions.</p> <p>Between the breast reduction and back operation with continous headaches and low selt esteem that i have to take my doctor to a physcologist/ The****** now and then which options will he advise me to take unfortunately I was denied that by the gate keeper.</p> <p>Now I have no option than to use thid forum all your internal systems have failed me. I am a mother i know the pain that my daughter is going through both physical and emotional, It is wron for anyone to dismiss me like this i need help for my daughter i ask for prevention not possible cure that will possibly keep us in thearter for a long time.</p> <p>Please help.</p>