Friday, February 17, 2017

Discovery discover new ways not to pay

.I dread every New Year, because until you consider what the new year means to those of us with a chronic or rare illness, you would consider me odd. It means the dreaded pre-approval and coordination of benefits, which translates into hours on the phone with people who have little or no understanding of the rare and chronic illnesses.  Trying to get approved for medications or treatment we need to survive and more often than not, we have been taking it for years, is a nightmare. Every year my physician writes the same letter.  The first year was a nightmare because Discovery had never heard of the diagnosis so there was no ICD 10 code.  But the last three years have been easy.  It was granted quickly. This year has tested my limits, and the limits of Dr Stern.  Instead of me receiving IVIG bi-monthly, Discovery have, in their wisdom, decided that I can only be treated once a month and it will be taken out of my hospital benefit. This is probably because the medication that I fought so hard for to be allowed into the country by the Medicine Control Board is so expensive.  In their wisdom, the Medicine Control Board closed the laboratory at the Western Cape Blood Transfusion Services and within one week, there was no medication for those of us who need it.  It is also used for burn victims.  I can only shudder to think about our burn victims in the state hospitals who have no access to Stabilized Human Serum.   The alternative to SHS is polygam, with is around R8000 a bottle instead of the R1200 a bottle from the WPBTS.  I cannot use polygamy because I am highly allergic to it.  Hence the fight to get the Octogam from the USA.  It costs R28000 for a bottle.  I am sure that Discovery’s refusal to give me the correct dosage is due to the cost of this medication.   How easily one could buy health if one was rich!  The motivational letter has explained to Discovery that without the correct dosage (bi-monthly) his patient is at serious risk of fatality from an opportunistic disease.   While I am most grateful to have a medical aid as many do not have one, it is still frustrating to pay R4506 a month to constantly be told to motivate the reason for the medication or treatment.  D96.8   At least we have a code now, but denying me the correct dosage of medication is a risk to my life. The first year I took Discovery to the Medical Control Board and an online interview was conducted.  Ten minutes before it was to start, I was given the authority.  It seems I am going to have to do that again this year.  Our constitution says we have the right to life, and with-holding my IVIG is a risk to that basic right.  When they closed the laboratory last year, Discovery paid for bi-monthly Octogam but this year they are refusing.  I was without IVIG for 6 weeks and could not leave my bedroom or see anyone because I had to stay in isolation.  I thought I was going to die, I was that ill without the IVIG. (IVIG stands for intravenous immunoglulin).I don’t think this is personal.  I think they operate like insurance companies.  There are standard letters that go out refusing approval and when the third letter arrives, then they look into it.  I don’t have the pleasure of many weeks or months to get this medication.  I am supposed to get it next Tuesday, but I cannot get a pre-authority in such a short time.  Even with a pre-approval from Discovery, I still have to phone in for a separate authority number every second week for the following week’s treatment.  The craziest thing about them denying me the IVIG bi-monthly is that they want motivation from an immunologist and they know (because I have asked) that we do not have an immunologist in South Africa. Bring on Monday Morning. I refuse to be buried until I’m dead – and Discovery will not make that decision for me. 
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