Poor service, total disregard for life and international treatment guidelines

<p>My fiance has been a member of a closed medical aid that is administered by Discovery, for a couple of years now. In May this year she was diagnosed with a rare lung disease which according to diagnostic classification is seen as a malignant neoplasm(cancer). </p> <p> </p> <p>Since her diagnosis in May, we have been trying to get her registered under the Oncology programme as well to have the treatment strategy by the oncologist approved. the first two treatment programs was declined by the medical aid as the one is a fairly new agent and not much evidence exists on this medication. the second was declined as its use for this spesific disease is outdated. </p> <p> </p> <p>The third submission by the oncologist included international proposed treatment guidelines with a spesific chemothe****utic agent- this was also declined ( reson being that there was not enough clinical evidence to indicate the safety and efficacy of the chemo medication), but they would consider the approval of Steriods.</p> <p> </p> <p>We then submitted numerous evidence based articles as well as the treatment recommendations from the international society, that states that the spesific chemo medication is safe and effective with huge success rate should the treatment start early. These reccomendations were made based on numerous international studies and clinical trails. The same literature also indicated that there were "NO" CLINICAL TRAILS that prove that the use of steroids is effective, and its use is maily anecdotal and based on expert opinion.</p> <p> </p> <p>Discovery basically declined clinically proven treatment, that has effectively been used since 1972 stating that there is not enough evidence for the use of this treatment, and that their dicision is based on "evidence based treatment protocols". We asked them to send us these evidence based protocol upon which their dicision was based on-we still have not recieved these protocols from Discovery.</p> <p> </p> <p>After submitting the appeal and providing even more up to date research for this spesific treatment, it once again was declined stating that there is not enough evidence to prove the efficacy for the treatment in "BOTH"lungs. Once again it was escalated and declined for the following reason "paucity of clinical evidence supporting its use, as well clinical guidelines search there are no prospective phase studies available". Yet multiple prospective phase studies and clinical trails have been conducted by the intrenational society, and the data has been published recommending the treatment submitted by the oncologist.</p> <p>Latsly regarding the registration with the oncology program, it was declined as the histology report does not confirm "cancer" as the diagnosis. The histology report does however include the diagnosis for the spesific disease, which according to local and international diasgnostic classifications, fall under the category of malignant neoplasms/ malignant tumours, which is cancer.</p> <p> </p> <p>As this disease is extremely progressive, we had to resort paying for the recommended chemo therapy privately. I find it unacceptable that the medical aid can decline internationally recommended treatment strategies stating that there is not enough clinical evidence (yet there is published clinical evidencde based on numerous studies), then reccomend treatment for which there is no evidence.</p> <p> </p> <p>We pay a fair amount each month for the medical aid- we should have to struggle and fight so hard for life saving treatment to be approved, especially if you qualify for the benifits and data to support the treatment</p> <p> </p> <p> </p> <p> </p> <p> </p>