1 reviews | Active since Apr 2015
Refusal of important medical treatment
Both my boys aged 7 & 11 have been diagnosed with immune deficiency. The eldest has low Igg & Iga & one of 7 low Iga. Eldest has received immunoglobulins for last 2.5 years. 7 year old struggles with constant infections, being sick every 2 wks. Although he doesn't have low Igg the Pediatrician suggested putting him on Perriglobin weekly to see if it will improve his health. 6 month's motivation letter was sent to Discovery and we received approval within 2 days. This had a huge impact as his infections drastically decreased. New motivation was sent by Pediatrician in Jan. but this time it wasn't approved and bloods were requested. After bloods, indicating low Iga it was again refused due to the reason: criteria not met. I immediately contacted Natasha to enquire how the criteria changed from 2014? She informed me that criteria was the same but they wrongly approved it in 2014? I informed her that it's unacceptable as I was never informed that it was approved by mistake, how is that possible to say it now! They put my son through the traumatic experience of taking blood and now they wrongly approved it? No feedback further feedback ! Top paying, Executive member, public must know!
Thank you for your comment.
The Scheme's role is to ensure members of the Scheme have access to quality healthcare in a way that remains affordable and sustainable. Some of the ways we achieve this, is in our plan and benefit design and the application of funding policies and clinical protocols.
I investigated your concerns and confirmed that you have been given detailed feedback with regards the request to have immunoglobulins funded from the Hospital Benefit. We do review funding for ongoing immunoglobin treatment on an annual basis. We base funding decisions on clinical information provided to us, your chosen plan type and the Scheme rules. We confirmed that based on the information provided the clinical entry criteria was not met and we cannot fund for the immunoglobulin from the Hospital Benefit. Our Clinical Team confirmed that we can fund the immunoglobulin from your available day to day benefit.
While we do understand that you may not be satisfied with this outcome it is in line with the Scheme rules.
Kind regards
Jashvir
Thank you for your comment.
The Scheme's role is to ensure members of the Scheme have access to quality healthcare in a way that remains affordable and sustainable. Some of the ways we achieve this, is in our plan and benefit design and the application of funding policies and clinical protocols.
I investigated your concerns and confirmed that you have been given detailed feedback with regards the request to have immunoglobulins funded from the Hospital Benefit. We do review funding for ongoing immunoglobin treatment on an annual basis. We base funding decisions on clinical information provided to us, your chosen plan type and the Scheme rules. We confirmed that based on the information provided the clinical entry criteria was not met and we cannot fund for the immunoglobulin from the Hospital Benefit. Our Clinical Team confirmed that we can fund the immunoglobulin from your available day to day benefit.
While we do understand that you may not be satisfied with this outcome it is in line with the Scheme rules.
Kind regards
Jashvir