1 reviews | Active since Mar 2016
PMB application going no where
My wife suffers from Trigeminal Neuralgia and has had brain surgery 3 times in this regard. To avoid a recurrence of the condition and further surgery our doctor has prescribed a drug which my wife takes daily. We app**** to Discovery to register this as a chronic condition and this request was turned down with their standard letter explaining that this condition was not on their chronic list. I called them and was told we could apply under PMB. More forms were submitted - (you can only deal with them through forms) and after numerous follow ups and a month later we received the normal pre printed response advising that this condition and medication was not on their PMB list. All these letters are signed (probably digitally) by a Dr Roach. I was advised that we could appeal this decision and this can be done by submitting yet another form. Every day I am bombarded by Discovery's propaganda encouraging us to stay healthy and here where we are trying to do exactly that we are being messed around until we hopefully go away.
Thank you for your comment.
The Medical Schemes Act defined a set of minimum benefits that must be provided to all medical scheme members. The benefit makes provision for the diagnosis, treatment and cost of ongoing care for a list of conditions as defined by the Medical Schemes Act 131 of 1998. Trigeminal Neuralgia is not included in treatment guidelines for Prescribed Minimum Benefit. Moreover, the Scheme has no mandate over the list as it is defined by the appropriate regulatory bodies, inter alia The Council of Medical Schemes. The Scheme does not question the necessity of this treatment and the funding thereof has not been declined. The treatment will be covered in accordance to your chosen plan type and subject to the Scheme's billing rules.
Regards
Norman
Thank you for your comment.
The Medical Schemes Act defined a set of minimum benefits that must be provided to all medical scheme members. The benefit makes provision for the diagnosis, treatment and cost of ongoing care for a list of conditions as defined by the Medical Schemes Act 131 of 1998. Trigeminal Neuralgia is not included in treatment guidelines for Prescribed Minimum Benefit. Moreover, the Scheme has no mandate over the list as it is defined by the appropriate regulatory bodies, inter alia The Council of Medical Schemes. The Scheme does not question the necessity of this treatment and the funding thereof has not been declined. The treatment will be covered in accordance to your chosen plan type and subject to the Scheme's billing rules.
Regards
Norman