HB
Heidi B

1 reviews | Active since Mar 2009

18 Jul 2024, 09:54

Unnecessary Drs visits to appease no one

The Dr's has been trying to get a medication approved for my diabetes to aid in weight loss. The initial application was done by my GP and the medical aid indicated that it must be perscribed by a Specialist Physician. After 11 attempts to find a Network specialist I eventually found one and went to see him. He agreed and sent a recommendation as insulin has a very high chance of making me pick up more weight that I cannot afford to pick up as it opens up your appetite and is a well known side affect. The application was submitted to the Discovery Chronic dept just to be rejected to say there is cheaper alternatives. Why then send me to a specialist physician if you know you will not be approving it. They just leading you around by the nose. They have no intention of paying for anything that your really need just the cheap and nasty stuff. This is exactly the same as the long release Glucophage they rejected for a very long time and I had to jump through hoops and could not go to work due to my upset stomach. You first have to have complications and be on deaths door before they will pay.

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Replies (4)
Discovery Health
Discovery Health's reply18 Jul 2024, 10:35
Official
Dear Heidi D

We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible. 

Regards 
Discovery Health Servicing Team
HB
Heidi B's update19 Jul 2024, 12:22
Reviewer Update
So this is Discoveries response. Sorry we made a mistake and they adjusted my claim to say my condition now does not meet the minimum criteria for the medication. PS the minimum criteria is Renal failure which I do not have. So basically they waisted my time, as well as paid money to a specialist not needed. They have no idea what they doing, they making it up as they go. No consideration for you as the patient just tick box exercises with general responses. As far as I know the medication is specifically designed for diabetics. I will have to go on insulin and pick up the weight and just get sicker.
HB
Heidi B's update19 Jul 2024, 13:20
Reviewer Update
Oh and I forgot, the original submission was declined with exactly the same reason i.e. condition does not meet minimum entry criteria i.e. renal failure they gave this time and I was told to submit an objection. The second submission I was then told I have to go so a specialist as a GP cannot prescribe the medication. After 12 phone calls and 2 days of searching for a network specialists I eventually found one, just to go back to the original reason. Makes no sense. Discovery does not know what they are doing, I have never seen so many mistakes in my life. Please note I was also sent(Discovery admitted) to a non network ophthalmologist at the end of May that cost me R1800 I am still awaiting an answer on. This has just disappeared into thin air. Problem in South Africa is are any if the other medical aids any better.
Discovery Health
Discovery Health's reply19 Jul 2024, 14:18
Official
Dear Heidi D

We have been in touch with you to answer your comments.

Regards
Discovery Health Servicing Team