Emergency Hospital Admision Denied!!!!

Nero Specialist wanted to admit me to hospital today 5th April 2018 emergency. During admission at my local hospital they called for authorization just before 17:00.

Authorizations at Topmed apparently uses qualified nurses to decide whether or not to approve your admission “over the phone”. Part of this process they want to speak to client to check their symptoms... I named a few like unable to sit, stand, walk, sleep sharp pain shooting down my legs, it’s worsening and not getting better, legs giving out, resulting in me unable to go to work due to exhaustion and frustration and in a hell of allot of constant pain. It was in a public area for all to hear and in front of hospital admin staff and people, I felt it wasn’t necessary for them to hear the other intimate gory details which is private and what I mentioned to my neurologist... for a male “nurse” to make prognosis over the phone whithout any more question in line with my symptoms authorization declined due to him feeling that I am trying to admit myself for pain treatmeant! Only time they will accept is if I come for an operation... well how do you expect the doctor to do so without MRI scans or checking if I don’t respond well to aggressive treatment, cause meds don’t work... and my symptoms all pointing to a deeper issue my spine... Yet he is qualified to make a decision above that of a specialist (a neurologist) and go above a doctors recommendation and decision and emergency codes!!!

That’s after a GP refereed me to a specialist and requested an MRI which TopMed don’t pay for unless it comes out of minimal savings (the scan raging between 8K to +|_15K) my yearly savings is less than 3K meaning they anyway don’t cover it. Which resulted in me doing regular X-rays that deprecated my years savings. Unable to continue to seek medical advise.

Resulted in me walking for nearly two weeks without proper treatment and worsening my issue resulting not being able to function properly, loo related issues, posture, sleep deprivation, intensifying pain, loss of feeling in limbs, or go to work and in me seeing a specialist today out of my own pocket cause my condition is just worsening and new symptoms occurring. A decision was made to be admitted into hospital. The poor specialist had to base his diagnosis on X-rays and in line with my symptoms. Cause I can’t affor a MRI scan and pay medical aid and Gap cover which won’t kick in if the medical aid don’t cobtrobute...

Yet that’s not good enough for a nurse at Topmed Authorizations! Even after the doctor indicated “spinal treatment” with its relevant codes, and during treatment he will decide which of the two operations we privately discussed he’d recommend based on my treatments outcome which a nurse blankly refuses me cause he feels it’s muscle plain related, well I’m no doctor but that type of issue is a result of something clearly much deeper and leaving it is worsening it day by day... I tried speaking to a supervisor I was advised no one was around just him.

In shock the admissions supervisor advised me to try again Phoned a second time, spoke to a female “nurse” just before they closed could hear the same male nurse coaching her in the background what to say and that without her even asking me my membership number or any of my particulars???? Make the same prognosis without asking me a single question regarding my symptoms.

What type of medical Aid is THIS??? she told me exactly what he said earlier and told me not even knowing who I was... when I advised her I would like to speak to him she rep**** “oh he left” but she could provide me with his name and exact wording he said and told me during my call, While I could hear him in the back ground.

Pointing to it again being a muscle pain related or disk and that I’m not covered for this in my sceme??? This all without my medical aid number, she realized she made a “rookie” mistake and eventually asked only to continue to tell me the same to rush this conversation to go home clearly, cause who has time to do their jobs right? So I asked her; basically you are telling me my medical aid is useless - she said yes... I even asked her so what would you want me to do carry on walking like this until an ambulance or airlift brings me in... she just rep**** I’m not covered for that and that will still be muscle related... who does that to a company they represent and work for, she confirmed the call is recorded and that I can just give their names. I only received one sms if the authorization being denied.

When the Admissions manager tried to find out what the issue was due to me sitting forever at their admissions area. The moment she saw the doctors code she said immediately spinal injury emphasis on “Spine” and not muscle related as the gentleman indicated when she tried calling they closed for the day. She was shocked at their logical explanation.

How can a nurse make prognosis without seeing a single scan, listening to my voice without seeing me physically or watch me walk, try sit down, stand or lay down and have this argument with me??? Clearly a qualified Doctor won’t admit people for nothing for emergencies!

I pay my medical aid every month for more than a year now only to get this at time of real need? What the hell am I paying for and why would Topmed let me walk around like this worsening my condition if they can treat and fix it? simply basically waiting for something small to explode into something much lager... my assumption based on today’s calls with two apparent qualify nurses I won’t be covered and stupid Me is paying a medical aid that’s “useless” cause it seems everything from bones to sore throat is muscle related it seems...

Condition they claimed it to be: Musculoskeletal Condition - well why do you think this is? Perhaps there might be something wrong with my spine not muscles??? Yet you let me walk...

People I spoke with: Viee Mavundai - very arrogant Jolene Govender

Shame on you, I only have one live and your gambling with it!!!