AW
Audrey W

1 reviews | Active since Sept 2011

11 Oct 2019, 09:38

SHOCKED that any Medical Aid has the authority to override a specialist script for high cholesterol

I am an oncology patient. The meds I am on has a side effect of raising your cholesterol and BP. I have just been for a Lipogram. The surgeon (specialist) strongly advised that I go onto a statin to lower my cholesterol (readings: Total=6.7, LDL=4.4 Triglyceride=2.25 and Non HDL=5.1). I sent the lipogram and script to Fedhealth. They have just come back saying: "Authorisation for payment of the condition - Hyperlipidaemia, unspecified - has been declined. Funding of this diagnosis is only considered for patients who meet risk score criteria, as set out by the Medical Schemes Regulations that define funding obligations." How high and how many areas of pathology marked "H" do they need before they will cover the condition!!!! I am SHOCKED that any Medical Aid has the authority to override a specialist script for high cholesterol, when our Dr's are fighting to keep us healthy. Is Fedhealth going to be there if (God forbid) I have a strokeor heart attack? No, they'll just send an email DECLINING aspects of any claim. I am angry and frustrated as you NEVER get to actually speak to the person (clinical consultant) who makes the decision. At the cal ...... it will be esculated (I HATE that word)

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Replies (2)
Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply11 Oct 2019, 10:11
Official
Thank you so much for your review we will be in touch shortly.

Kind Regards
The Fedhealth Online Team

Fedhealth Medical Scheme
Fedhealth Medical Scheme's reply15 Oct 2019, 08:43
Official
A consultant has been in contact with you and detailed feedback has been provided. 

Kind Regards 
The Fedhealth Family