Oncology Benefit not being Honored

My mother in law. Mrs Mather was diagnosed with Lung cancer on the 15 of March 2019. After conducting various tests, results showed extremely high PDL1 levels of 90%. Due to these results her oncologist recommended that Immunotherapy would be the best treatment using the drug called Keytruda (Pembrolizumab). However, due to her medical aid scheme Discovery declined the application of the funding for the Keytruda,. Mrs Mather decided to self-fund the Keytruda at a high personal cost.

Our grievance is with Discovery for declining and refusing to pay the administering (infusion fees) of the Immunotherapy (Keytruda) even though she has available oncology benefits which funds the administering of chemotherapy in the same way in which the Keytruda is administered

Please contact Shehnaaz if you wish more details. ***

WHAT RECOURSE DO WE REQUIRE? Since Mrs Mather is self-funding the Keytruda at a very high cost of R95 000 per treatment, the least Discovery can do is fund the infusion fees from the available oncology benefit