Removal of

I would like to bring attention to the disgusting financial practices being app**** by discovery health currently and the inconsistent support we are experiencing from 2019. This also heeds as a warning to any potential new members thinking of joining this "scheme" and going through the same process and disappointment. My wife had difficulty inserting a Mirena® (levonorgestrel-releasing intrauterine system) IUD in practice, approx. 2,5 years ago, and she had to obtain medical clearance to perform the procedure in theatre to have it inserted. This was cleared and paid for by Discovery, in hospital. Now that she wants it removed, to have a second child, again not being able to get it removed (after 2x attempts in the doctor’s practice,) we require clearance to remove it in theatre. Which makes sense if you apply some common sense. It is the same human being that requires the same in theatre medical assistance to remove the same device. It is not cosmetic, it is a procedure to restore the reproductive cycle of a woman of child bearing age. Discovery refused to give that clearance, despite the Doctor giving clear and concise motivation as to the reasons why. This is completely inconsistent from the decision to give clearance for insertion. The device also has a 5 year life span and will need to be removed in theatre after the period expires. To us it seems that this is the “schemes” way in deterring us from trying to have additional children and claiming from the fund, by forcing us to pay for a required procedure in hospital and/or forcing my wife to endure the pain in practice. (Even after attempting numerous times to have it removed in practice and enduring said severe pain). They also escape their duty for paying for in-hospital procedures, which is the main reason we have medical aid. Now the question begs, how many medically required in-hospitals procedures will they decline in future? I have lost complete confidence in this “scheme”.

Their reasons for rejecting is stated as below, verbatim: ------------------------------------------------------------------------------------------- "We make **consistent and fair funding decisions** in the interest of all our Scheme members. We recognize that the treating doctor is in the best position to make medical decisions about Mrs ****** condition and treatment. In reaching this decision we have not questioned the diagnosis or the treatment the doctor recommended. As a healthcare funder, we decide on funding treatment to make sure the Scheme can cover claims now and in the future. We have a responsibility to make sure members of the Scheme enjoy access to quality healthcare in a way that stays affordable and sustainable. Some of the ways we achieve this is in our plan and benefit design, the creation and application of funding policies and clinical protocols that are developed using a rigorous, evidence-based decision-making process. This process also helps us make decisions about which procedures and treatment to exclude from cover. We hope this clarifies the reasons for declining your funding request." ---------------------------------------------------------------------------------------- Why would insertion be approved (in theatre) and removal (in theatre) rejected? I leave you to make your own conclusions.