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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