No payment for CPAP machine URGENTLY needed!

We requested payment from the Major Medical Benefit for a CPAP machine for my husband, He was diagnosed with SEVERE Obstructive Sleep Apnea. (AHI index 64 – stops breathing 64 times per hour).Suffer from Hypertension, and a big risk for a stroke. - Our GP is very concerned about his health.

Discovery paid for the night in the clinic for the sleep study from the Hospital limit, as well as another night when he was monitored on the CPAP machine. We’ve requested payment for this machine (R 15 329.11) from the Overall Limit – and NOT ONLY R 4500 .00 FROM OUR SAVINGS account – was declined. (If paid from savings, they will only pay R 4500, although we have a balance of a much higher amount. SAVINGS is for the member to manage????)

Please have a look at our Claims payment History – we are NOT high claimers. We are members of Discovery for +- 20 years already. Montly fees paid on the date for the month, NEVER in arrears.)

This machine will improves his quality of life, and assist with his Hypertension, as well as preventing a stroke. (Which, if it happens, will cost the Scheme MUCH more than R 15 000.00.) Why cant they realize the benefit of this machine????????

Please assist us with this urgently, as he needs this machine ASAP. This has been going on for two weeks already. I logged a complaint with The Council of Medical Schemes (CMS 79554) The turnaround time is 120 days!!!!!!!!!!!!! He CANNOT wait that long. I can forward ALL supporting documents, report of sleep study, motivation of dr etc.