My husband had his PMB condition approved when we joined LA Health (Had to pay the specialist to fill in the numerous pages of application). We had always called it a Chronic condition, which it is. Unfortunately for us LA Health employs Discovery as administrators. Clearly, Discovery expect their clients to be Experts in Language & Semantics. When Discovery declined to pay for the chronic meds prescribed by the Specialist we duly went back to ask him to prescribe one of Discovery's preferred meds (love it how a corporate tells a doctor what to prescribe). I take it to the pharmacy to fill - they tell me it is not accepted on Chronic. Write an email to Discovery (to which I am still waiting for a response) then phone the call centre. I am told I have to email the new script which I duly do. Today I wake up to an email from Discovery saying the meds are declined because 'no diagnosis' was given with the script!! I phone Discovery with the date of the letter confirming acceptance of the condition, with a Diagnosis! "Oh, but because you called it a chronic condition we could not accept it" says the agent. Guess what? - the correct name for it is a PMB! Silly me.
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