Why do U oay for a medical aid but get no aid.

I’m a healthy, hard-working father and husband and also a member at Discovery health medical scheme since 2015/01/01. Never had any problems with my health and neither with any-one in my family and also don’t make use of alcohol or tobacco . On 18 November 2016 I decided to go to work using my motorcycle, on my way there a taxi driver that was standing in the oncoming traffic and waiting to turn into another street decided that he had waited long enough for me to pass him and drove right in front of me. In the collision my back from vertebrae T5-T9 and also my right femur broke and left me a paraplegic. While I Was at Meulmed Hospital in Pretoria everything went well with my medical expenses and I got more efficient at caring for myself in my new situation at the Summit Rehab centre. I was discharged on 13 January 2017 and was at home for 2 weeks and started working again at my same work before my accident and in the same position till today. On the 30th June 2017 the pharmacy where I got all my medicine and so forth from notified me that there is a problem and that my acute medicine plan was depleted on my medical scheme and that I would have to pay for the medicine needed myself witch was roughly R3000 per month. With making an enquiry I learned that the application to put my medicine on the chronic benefit of my medical scheme was never sent in or even filled in witch to my knowledge was done when I asked the Doctor while I was being discharged from hospital. So started a very long fight with my medical aid provider. It took me a very long time to get the chronic application documents for cover from Dr DWH Terry’s assistant ( Jeanny Keyser) filled in and sent back (from 2017/07/17 till 2017/08/14) witch was the wrong application form because we were in year 2017 and she sent thru a 2016 application form. With another log wait and constant emails ( from ***) I received the 2017 application form from a colleague( Liezl Slump) and sent it thru to Discovery for approval. The application was declined and we had to fill in an appeal form witch I again needed to send it thru to Miss Jeanny Keyser at Dr DWH Terry’s office on 17 Oktober 2017. On the 4th November 2017 I still didn’t get any feedback or filled in forms and decided to write an email to Patient Experience Manager at Mediclinic Meulmed hospital to ask for help because it was a constant wait to get the necessary documents from Dr Terry’s office. On 7 November 2017 I got the appeal form back and filled in with the help from the patient experience manager and sent it thru to Dicovery medical aid witch stated I will get feedback within 2-3 working days. On the 23rd November 2017 Nadie Charles from Discover that took my case to see where she could help sent me an email telling me the she sent an email thru to Dr Andries Visser’s office on 9 November 2017 requesting a motivation letter from the doctor why the medicine described in the application was necessary but never got any feedback, so I contacted Lucia Van Vollenstee the Financial and Practice manager of Dr DWH Terry and Asssociates by email and asked for help and to witch she rep**** she will check in to it and get back to me. With their help miss Jeanny Keyser from Dr DWH Terry’s office sent me the motivation letter needed. On the 14th December 2017 I received a letter from Discover that my application was again unsuccessful and that the medicine requested was not on the formulary list for this Prescribed Minimum Benefit and every time I asked for the list of medication covered so I can see what alternative the is they tell me there is no list and that doesn’t make sense. Why would the doctors put people that is admitted to hospital like me that needs specific medication to go on as normal as possible and need specific items to take over the work that normal organs would do on medication and items like my catheters that isn’t cover by medical aid’s after a patient is discharged Till date I have even been to a Neurosurgeon and Urologist but even with their motivation discovery still doesn’t want to cover my medical expenses and also a letter from the attorney that handles my RAF case that states all medical costs would be paid back after the claim has been settled. Even going to a higher medical cover plan with Discovery would not guarantee that my medicine and other needs would be covered and currently our financial status doesn’t provide us with the option to go to a higher cover plan. Here is the problems I think anyone would have that is in the same position as me that would really need the medical aid to look after U when needed: 1.) So if you are healthy and a member with Discover medical aid they will take care of U with the day to day needs like flu and so forth 2.) If you go to the Hospital and your medical aid states that all costs in hospital are covered you will be ok 3.) Should you be discharged from hospital you will be on your own with no help to the specific needs to go on as “normal” as possible as was used in Meulmed Hospital, below is the details of items that was prescribed to me but only paid for while in hospital. a) The medicine listed below as used and prescribed to me in Meulmed Hospital by DR DWH Terry that enabled me to go on as “normal” as possible to keep the spasms and pain at bay. Targin Act 20/10 one tablet twice daily (60 per month) Xefo 8mg one tablet twice daily (60 per month) Lyrica 50mg one tablet twice daily (60 per month) Trepeling 25mg once at night (30 per month) Movicol 2 sachets daily ( I stopped taking it and went to a natural bowl reliever) That totals an amount of R2487.79 per month at this time. Why are they suddenly not covered by the medical aid on the chronic benefit? b) The catheters Bard Magic3tm (Intermittent catheter with sure-grip sleeve hydrophilic coated silicone) was also prescribed to me and also maybe all the men at the time of my stay in Meulmed hospital by Dr DWH Terry and associates. I need to empty my bladder every 3 hours so that totals an average amount of 180 catheters (R54.92 each) needed per month witch currently costs R9885 per month at this time.

4.) On the Hospital side: a.) Who is responsible to apply for chronic cover of the medicine prescribed by the hospital’s doctor? b.) Why does a person( me in this case) need to phone constantly and also ask colleagues or even the administrators of the hospital to get the necessary application documents filled in that is needed for cover by the medical aid that was supposed to be done already before I was discharged?