LA Health/Discovery their not looking after your health, they're more concerned about their pockets.

I have been a member of LA Health for a number of years now, literally from their inception in the market as a Medical Insurance, a subsidiary of Discovery Health.

In September 2014 I was diagnosed with an Auto Immune Disease, initially Rheumatoid Arthritis (RA) and was treated with the basic meds to combat the initial symptoms, I was covered by LA Health for said meds (NSAIDS)

At the time I was on the LA Active Plan which covered most of these meds.

After 12 months with no improvement and two specialists later I was referred to a Rheumatologist in the EdenGlen Hospital, brilliant woman, who kept me in hospital for 5 days in order to get to the core of my disease. This process and several scans later changed my diagnosis from RA to Ankylosing Spondylitis (AS) an auto immune disease which affects the spine and peripheral joints by fusing themselves together until eventually I will no longer be able to walk or function properly. A grim reality to be faced with and something that took a while to get over.

I was then forwarded to an AS Specialist and proceeded to begin the process all over again with the applicable NSAIDS. Methotrexate etc. The side effects were unsettling to say the least, MTX being a form of chemotherapy used to subdue the immune system in order to be able to cope with the constant pain. (24/7)

This process, I was informed had to be completed in order to apply for Biologics, which in turn would shut down my immune system and afford me a 70% chance of being able to be pain free and to function properly or at least to the point whereby I could live a somewhat normal life. This was supported by a certificate from the South African Rheumatoid Association.

After the 6 months and numerous more treatments an application was forwarded to LA Health for the Biologics which was inadvertently turned down, reason being, my plan did not cover the AS. Their advice at the time was to upgrade my plan to a plan that covered AS in order to access the drugs, but that said upgrade would only be considered in the new year.

6 months later I was upgraded to LA Core, at a substantially higher premium but AS was the first condition on their list that was covered by this plan.

In January 2016, two years after my original diagnosis I app**** again for the Biologics, with the help of my Rheumatologist and all the required documentation, reports, scans, certificates from SARRA etc.

LA Health turned me down again, this time citing that they covered the disease and NSAIDS on this plan but not the Biologics. A request to upgrade to Comprehensive was addressed but was also rejected based on the fact they only do upgrades at the end of the year.

In other words, LA Health was aware of my condition, aware of the symptoms but felt it fair to make me wait another 11 months for treatment.

I refused to accept that and made an application to their Ex Gratia facility which if successful would support me for the 11 months with the required drugs I needed until I was given the opportunity to upgrade to Comprehensive, again, all documentation was forwarded with a breakdown of my condition, reports from Rheumatologists, Recommendation from SARRA and scans etc.

I was turned down again.

Again I was left hopeless, despite all the enquiries, phone calls, letters I was continually told to come back in 11 months.

At this stage, I was on the highest doses of NSAIDS that were prescribable and still my condition was deteriorating. The lengthy use (now almost 2 years) of the NSAIDS began to have negative affects on my health, so now ultimately, I had to deal with both AS and the side effects, which included my hearing, my vision an operation related to kidney infection.

In August 2016, shortly after my operation to resolve kidney problems an audiologist recommended hearing aids, LA Health turned me down yet again.

During this whole process my attendance at work was getting worse and worse, eventually leading to the point where I had to apply for extended sick leave in order to deal with the AS, Side Effects and subsequently, depression.

I was booked off work for more than a year.

In November 2017, I eventually lost my job due to Disability. A 30 year career, 25 with this specific company. Gone.

In the same month I app**** to be upgraded to the Comprehensive Plan, it was approved in the same month.

January 2018 another formal application was made for the Biologics, I'd ticked all the boxes, followed their advice and still I was turned down again, this time they required more paperwork. We forwarded them 3 Years of evidence, still wasn't enough.

on the 18th of January I was then informed that LA Health had never upgraded me and that I was still on the previous plan. After spending 20 minutes on the phone explaining that I had confirmation that my upgrade had been approved the issue was corrected and my records were amended accordingly.

But the Biologics still haven't arrived.

Eventually a friend who had watched this whole process go down, made a complaint on Facebook. I was called the following morning by Matthew, who politely told me I was being treated as a special case because I had been upgraded to Comprehensive in January which was not the norm. *******. Somebody at LA Health didn't do their job. Despite the fact it was my health they were playing with.

I was called back on the same afternoon and told that all my submissions over the last three years had been collected and forwarded to an external panel of Dr's to make a decision. (no further documentation was needed) The finalisation of this process cannot be predicted by LA Health due to the fact that the panel of Dr's reviewing my application worked at their own pace.

Yet again I would have to wait but Matthew would come back to me on Friday to let me know where in the process I was. To date, Ive never heard from Matthew again.

The following Monday another complaint was posted on Facebook and the following day I was contacted by Linda from LA Health who assured me that she would take care of the processes and keep me updated, she agreed to call me on the Friday for an update. That was 3 weeks ago, I haven't heard from her yet and still no meds.

Quite honestly Im done. I am in pain 24/7 I get up the stairs at home on my hands and knees, I struggle to shower, get dressed, drive a car, walk, sit down, brush my teeth.... Ive had a 30 year career ended because the absolute lack of humanity from these people. I have never in my life experienced such an inhumane act, nor have I heard of any other medical insurance company make a patient wait 2-3 years for medication, then when the medication they have forced you to stay on starts affecting the rest of your body the same company refuses to assist with that as well. This is not a medical aid....this is a medical embarrassment and disgrace.

This is about money, not your health.

I am 48 years old and now useless because of the lack of professionalism from these people.

My applications were turned down repeatedly, yet 4 weeks ago I was told by Matthew that this would be the first time the Dr's would be reviewing my application. If this is true, who rejected my initial applications, what medical qualifications do they have to make such a decision in spite of reports and recommendations from Specialists and the South African Rheumatoid Association. Truth is, administrators turned me down, not once, not twice but 4 times, despite my condition and despite the fact that due to the delay in obtaining these drugs my condition would get worse, I would be fighting not only the AS and the possibility of ending up in a wheelchair but the plethora of side affects associated with the drugs they forced me to stay on.

I'm done. If you're considering a health plan avoid Discovery at all costs, they don't care about your health, they couldn't give a ****. They're worried about the money.

My Biologics, Enbrel would have cost them R9000 a month.

Instead, I have a lot more issues that need resolved, the damage incurred over the last 2 years is permanent and non reversible, the pain I have gone through, indescribable.

I would not wish this on anyone.

Stay Clear of these people.