NC
Neil C

1 reviews | Active since Mar 2009

21 May 2015, 12:54

Pre-authorization declined

Can someone in Discovery Health please respond to me personally why EXACTLY the pre-authorization for the removal of the calf prostheses were declined which originated from polio when she was 18 months old? The prosthesis was inserted in 1981 and is currently causing a health risk.Please find attached the ICD10 codes we submitted together with the doctor's letter regarding her current condition as well as probably the vaguest response from Discovery below which is totally unacceptable. For a family that has no serious health conditions, a sister assisting elderly patients to have the ability to walk again and can't gain health care for herself when she needs it the most is disgusting!<br> Request for removal of lateral calf prosthesis <br> Thank you for sending us the details of your planned procedure. We referred your request for funding for procedure to our medical review team(Who exactly is this team and what are their qualifications or is the \medical review team"actually either an automated tick box program or greedy accountants). We regret to advise you that your request for funding was declined because this is a complication of general scheme exclusion."""

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Replies (1)
Discovery Health
Discovery Health's reply22 May 2015, 11:56
Official
Hello webmaste,

Thank you for your comment.

Due to the Confidentiality Act, the Scheme is unable to provide you with any information on the membership unless we receive written confirmation from the principal member. I can confirm that we've provided feedback to the principal member.

Kind regards
Rishana