SUBMIT A COMPLAINT

Discovery Healthhuman rights violation

Good day,

I'd like to start off by explaining my personal situation. I am a single mother of a 4 year old son. I stay with my parents as i cannot afford to live alone. My son’s father does not pay maintenance on my son. Understandably I do not have the funds to pay excessive amount due to medical aids being incompetent.

Firstly I would like to draw your attention to an instance in June/July 2014. I was placed on a waiting period for chronic conditional bipolar disorder. During this period I paid all my medicine out of pocket. Being an acute sufferer of depression I had a nervous melt down due to ongoing financial pressure. I tried committing suicide and was admitted to Palm Tree Clinic in Cape Town. Discovery refused to authorize the hospitalization as I was on a waiting period. The treating psychiatrist (Dr K Moodliar) made various attempts to stress that I needed the treatment urgently and explained the severity of my condition. I was 2 months away from being off my waiting period still Discovery refused and offered not alternative or help regarding my treatment. Consequently I paid the entire two week stay, medicine and doctors’ bills out of pocket. I am still paying back these bills after I went into a payment arrangement with the various suppliers. These bills together will probably amount to well over R 30 000.00

On the 2nd of December 2014 after having waited a year and paying all medication out of pocket I sent through me chronic application for Bipolar. After various telecoms to Discovery I was informed that they would only cover a slight portion of medication needed. I take Aspen Trazadone 100mg nocte and Venlor 300mg in the morning. My first application was rejected as the doctor did not include epitec into her treatment base. My second application was approved for Trazadone but not for Venlor as they are apparently both an anti-depressant. I tried to explain to Discovery that I understand their formulary lists but combing all patients under the same rule seems somewhat unfair. My medication is over R 1200.00 per month. This may seem like a small amount but taking that, together with the fact that i pay full medical aid and I am a single mom... The explanation was given that Discovery does not pay for Serotonin–or epinephrine reuptake inhibitors which would therefore mean that all patients suffering from Bipolar Disorder have to be on the same medicine even though it has no effect on their emotional wellbeing. I have had depression for numerous years and psychiatrists have tried various combinations of medication but I never relieved the symptoms. When they however found the combination that improves my emotional state Discovery was not willing to review full payment of these medicines. I therefore still pay my chronic medication out of pocket and this has, in the last 14 months costed me a minimum of R 20 000.00 already. The doctors have now put my on sleeping tablets as well but i dread sending this application through as I know that they will have an excuse not to pay this too.

On the 9th of February 2015 I Contacted discovery regarding authorization for spinal surgery. As per the specialists notes on the MRI and X-rays there is a severe instability on levels C5+C6. An authorization number was given but I was informed of a co-payment to the hospital of R 11 550.00. I do not think they fully realize the severity of this situation. I contacted them various times on the 10th of February 2015 to get clarity and to request if they would not please review. Again, they offered no solution to the problem. I switched over to a higher plan as to ensure we (my son and I) have more comprehensive cover should we need it. I told them over the phone that i was not aware of the fact that there would be such a large co-payment on spinal surgery as i would not have moved over to that plan if I knew. I broke my neck in a vehicle accident eight years ago and have a fusion on levels C4+C5. I therefore thought that i needed good cover for spinal should something go wrong at some stage. I would therefore not have made the decision to move over to this plan type considering the injuries sustained. As per Discoveries explanation, they are not financial advisers which I understand but surely they should inform members of the pros and cons of moving to different plans. I am now in a predicament as the doctor explained this is very urgent surgery (as he classified this as severe instability) but do not have the funds to pay for this. I have had to cancel my operation and am now running the risk that should I sustain any neck injury, I will be paralyzed.

I wish to draw your attention to the Bill of Rights of South Africa.
Section 11 states: "Every person has the right to life" - the full meaning of the word life is: "the condition that distinguishes animals and plants from inorganic matter, including the capacity for growth, reproduction, functional activity, and continual change preceding death."
a) Refusing to cover my entire hospitalizations for my neck is taking away my right to functional activity as I am restricted in my personal and professional life due to the fact that I do not have access to the full use of my neck.
b) Refusal to pay my admission for bipolar when it was a clear medical emergency as per section 27.3 of the constitutional act almost cost me my life.

Section 12.2.B&C "(2) Everyone has the right to bodily and psychological integrity, which includes the right-
(b) to security in and control over their body;
- Placing patients under a formulary law that states/indicated all patients with a certain condition need to take certain medicine is taking away the patients control over their own body
- Refusing to fully pay my hospital admission for my neck fusion will eventually cause me to lose control over my body as my neck's condition degenerates daily. Should I sustain an injury at this point the chances of losing function of the rest of my body are 99.9%.
And
(c) Not to be subjected to medical or scientific experiments without their informed consent."
- By refusal to cover chronic condition medication in full, I am being subjected to their experiments as I am forced to take medication in their formulary lists of pay my medication out of pocket which I can truly not afford.

Certain professionals in our country have a responsibility to aid in the bettering of the nation’s health. Discovery Health has however not just on one occasion put my life at risk with their absolute nonchalant attitude towards their clients. Being a health and safety practitioner (in construction) myself, I know that when people's lives are stake, you need to go the extra mile to ensure they are safe and healthy. I also know that you cannot treat people in a way that could cause harm or injury as per the OHS act. Compassion is key in this industry and without this you merely function as an organization that is out for people's money. Further to that they have not only placed me at risk numerous times but have over and above what I can afford made sure that they are covered as not to pay claims. I feel exploited and they have gone beyond all means to ensure I do not receive the medical care i need.

There has been an irreparable breakdown in relationship between myself and Discovery Health. I have lost all trust and belief that they are able to provide in my healthcare needs and that they have my sons and my health as a priority.

Could you please provide guidance on how this matter can be resolved as I cannot allow this any further?

Gr
Feb 10, 2015

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