Waiting for me to have a Heart Attack before they will fund life saving device

I am writing this to express my absolute disgust at Discovery Health’s decision to decline funding for a life-saving CPAP machine from my risk/scheme benefits, despite overwhelming clinical evidence of Severe Obstructive Sleep Apnea.

My recent sleep study confirms an AHI of 33 (Severe) and, most alarmingly, that my oxygen saturation levels drop to a life-threatening 59% during sleep. My doctor explicitly stated that this machine is mandatory for my survival and long-term management, especially considering I am already being treated for hypertension and have a very high BMI.

The scheme’s response is nothing short of clinical negligence. You have declined the benefit on the basis that I do not yet have "diagnosed right heart pathology." In plain English, Discovery Health is telling me that they will only fund the treatment once my heart has already been permanently damaged by the strain of not breathing. This is "reactive" medicine at its most dangerous. You are waiting for me to have a stroke or heart failure—which will cost the scheme millions in ICU fees—rather than paying for a preventative machine now.

Furthermore, telling a member that this life-saving equipment is only covered on "Executive or Comprehensive" plans is discriminatory. Medical necessity does not change based on the size of a member's monthly premium. Severe Sleep Apnea is a chronic, life-threatening condition, not a luxury lifestyle choice.

By stating that you will only pay for this from my Medical Savings Account (MSA), you are effectively wiping out my entire year's day-to-day cover for a single piece of essential medical equipment. This leaves me and my family vulnerable for the rest of the year.

I demand that Discovery Health reviews this decision immediately. I am not asking for a "nice-to-have" gadget; I am asking for the equipment required to keep me breathing at night. If this is not resolved, I will be taking this matter to the Council for Medical Schemes (CMS) for a formal ruling on the grounds of medical necessity and the prevention of secondary cardiovascular complications.