Discovery Health
Medication for my PMB condition has been refused

Discovery has told me that I am not on the right medical aid plan to receive treatment for Crohns disease (which is on the PMB list) I was told I need to upgrade to a higher plan to fund the drug called Humira. I told them that I am happy to do so but they said I have to wait until the end of the year as that is the only time that they allow members to upgrade.

Unfortunately for me, my doctor says I cannot wait that long as the rate at which my health is deteriorating might force me to have a permanent ileostomy performed. I am 32.

They have refused to do any more for me until I upgrade at the end of the year. Myself and my doctor sent off an Ex Gratia application and they still said no. They said I must fund it myself (after looking at my bank statements and seeing that I obviously can't afford it) or try other medication. My doctor says my only options are a permanent ileostomy or Humira.

Now, it is my understanding that as a PMB, this disease and its treatment should be funded by my medical aid, whom I have been with since 1995, regardless of what medical aid plan a person is on.

[URL Removed]

Please help me if you can

Regards
Graham

Company: Discovery Health
Country: South Africa
City: NATIONAL

  <     >