Good day,
My mother was diagnosed with esophageal cancer about 15 months ago. There is a procedure that can be done to remove the Barret's esophagus that is causing the cancer. She was on a lower plan and was told by a Discovery consultant that if she moved up onto the highest option Discovery has to offer then she would be covered for the procedure but if she stayed on her current plan she would not. I have been paying her medical aid for the last six months on the highest plan of R6004.00 as per the consultants advice. I have details. The procedure which cost R30 000, 00 has been denied on four attempts of pre auth, because the levels of displasia are not high enough. I want to know why a life saving procedure which at R30 000, 00 would cost less than the surgery which would cost probably in excess of R250 000, 00 baring any complications, and would more than likely lead to her death, is being denied because she is not sick enough? We have spoken repeatedly to numerous call centre staff and all we get is that my mom needs to be more sick than she currently is before they will auth the procedure. Not even her Doctor/Professors motivations have had any luck. Why?
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