Unjust Co-Payments Impacting Essential Care for Child with Severe Cerebral Palsy

I am writing to express my deep frustration and disappointment with Discovery Health's handling of my daughter's medical situation and the imposition of exorbitant co-payments despite our unique circumstances. I have always wanted to keep my child's medical history private but discovery is leaving me no alternatives.

I have a 10-year-old daughter, who suffers from severe cerebral palsy, is non-verbal, epileptic, and has no motor control. The handling of her medical care and the financial burden imposed by Discovery Health is significantly impacting her treatment.

On July 24, 2024, my daughter underwent a crucial tendon release surgery. Due to the specialized nature of her condition, none of the orthopedic surgeons at the designated Delta hospital were equipped to handle her case. Our doctors referred us to Mediclinic Louis Leipoldt, where a surgeon specializing in cerebral palsy could perform the procedure. Despite the medical necessity of this referral, I was forced to pay a co-payment of R10,200 as Mediclinic Louis Leipoldt is not part of the Delta network.

I appealed to the medical aid review board to waive this fee, considering the lack of suitable medical expertise within the network and the importance of continuity of care for my daughter's well-being. Unfortunately, my request was denied, and the review board suggested we seek treatment at Life Vincent Pallotti hospital instead. This suggestion ignored the fact that none of the doctors at Life Vincent Pallotti have an established relationship with my daughter or access to her comprehensive medical history. Moreover, the hospital has received numerous negative reviews, casting doubt on the quality of care they provide. The surgeon at Mediclinic Louis Leipoldt had been collaborating with my daughter's medical team at Mediclinic Panorama for months, ensuring a seamless and well-informed approach to her treatment.

Despite these critical factors, the medical review board upheld their decision, forcing me to pay the exorbitant co-payment to ensure my daughter received the best possible care. While the surgery was successful, we now face the prospect of another R10,200 co-payment when my daughter requires hospitalization on August 7, 2024, for the removal of her casts under anesthesia.

I am deeply disappointed and frustrated by Discovery Health's inflexibility and lack of empathy in this matter. My daughter's well-being should be the paramount concern, and imposing such substantial co-payments, despite the medical necessity and our extenuating circumstances, is both unjust and financially burdensome.

Additionally, my attempt to change my plan to the Coastal Saver option, which would have alleviated the financial strain, was summarily dismissed due to a mere R23 difference, inexplicably deemed an "upgrade."

On several occasions we have tried to implore Discovery Health to reconsider their stance and waive these excessive co-payments. Their failure to accommodate our unique situation and prioritize my daughter's health over is deeply disappointing and fails to uphold the principles of compassionate and patient-centered care. To add to this, there is no financial loss suffered by Discovery in us using the facility we used at all providers have arrangements with Discovery and the cost would have been the same at the Mediclinic we normally use which is part of the Delta network, had there been a specialist available for the procedure.