Question Time

I have three issues that I have it DHMS. Today I finally figured out why I have so much nonsense with DHMS. Ilogical thinking, lying, and just plain uselessness!

1- I have a PMB condition application that DHMS refused. The CMS, in cohorts with DHMS, agreed. DHMS basically has said in a round about vway, that the healthcare provider and I have submitted a ********** application. All because DHMS clinical review committee cannot make a logical decision based on facts at hand.

Now that I have lodged an appeal with the CMS and my intermediary become involved, all of a sudden the clinic help department can assist. Two weeks plus of me emailing clinical help, and no response. But given my other issue, I understand why DHMS cannot assist. They have no clinical representatives.

2 - DHMS owes me money. Now that DHMS owes a member money, they are using stall tactics. Lying to the member, making useless excuses, and giving arbitratoy reasons. In the end, the member looses and DHMS wins. Typical.

3 - I have another PMB condition application issue. It's simple if you apply logic, but as DHMS representatives don't know how to apply logic, it's making a simple process difficult. DHMS logic: a child can not be seen by a Paediatrician, who's speciality is children, for the assessment of a condition, nevermind on going treatment. But if said child was an adult, then a specialist who treats adults, will get you the same benefits. Huh???? How is the remotely possible DHMS????

The cherrie on the cake, a non clinical qualified DHMS representative has made this decision, yet said representative is in the clinical review department. Explains my other issue in point 1.

Question time DHMS:

a) How can DHMS have non clinical qualified representatives in a clinical department? (confirmed representative in question is not registered with the HPCSA) Or does DHMS think a pharmacist is better suited than say a neurologist when dealing with a neurological problem?

b) Why does DHMS not pay attention to what members say in in correspondence?

c) Why does DHMS representatives not confirm correspondence already sent to a member, before sending correspondence that is basically a lie?

d) Why does DHMS not adhere to the NCR which is superior to the MSA?

e) Why can't DHMS clinical representatives, besides the fact that they are not clinical in any form or way, figure out that treatment was given as per the basic information at hand? Any person with some clinical experience can figure this out without any doubt. Especially when a member referred the clinical representatives to a DOH document confirming treatment for the condition in question and using the medication in question to treat the condition?

f) Why must intermediaries help members? What super powers do they posses that members don't?

g) This is the best question, why is DHMS not concern if a member approaches the media with the issues they have with DHMS? Considering all the negative reports of DHMS treatment of healthcare professionals, and considering too, that part of the issue the member has, is to do with DHMS, in a round about way, is accusing healthcare professionals of *****.

In my many correspondences with DHMS, I was told this!

DHMS, am not sure if you can respond to any of my concerns or questions, given the service so far, but I will give you a chance to redeem yourself.