Fedhealth Medical Scheme
Declining chronic medicine after option change

I have been getting Humira Injections for Chron's Disease for the last 3 years while I was on the Maxima Plus plan without any issues or test requirements. At the beginning of the year I changed my plan to Maxima Exec plan and after that applying for my Humira it first was rejected because they want a colonoscopy done. After my Specialist wrote them a letter stating that no matter the outcome of the test he does not want to stop the treatment. After waiting for more than 25 days to review it again they decline it again with no reason given to me directly only a report will be sent to my Specialist. This after I have a letter from Fedhealth stating that Humira will be covered on the plan I changed to. I then asked if any of the Doctors on the panel is a qualified Gastroenterologist on which the answer was no. So my Question now is how can a Panel make decisions on my health and what medication I need if not even one of them is a specialist in the field of my Disease and how can they override a prescribed treatment by my Specialist who is a Gastroenterologist? Seems to me that this is clearly a financial decision and its not made with my health in mind.

Company: Fedhealth Medical Scheme
Country: South Africa
City: Chronic Medicine Department

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