Today I have reached the absolute end of my tether. I suffer from a myriad of Auto Immune Diseases that are all chronic conditions and take every ounce of my focus, positive attitude and strong will to simply keep moving day to day. One of the challenges of my disease is that I often get chest infections and have trouble breathing. Having suffered with these diseases over the last 9 years has been a daily exhausting fight to survive at times.
I have been a loyal client to Discovery Health for well over 22 years and to date have always had excellent service and support to help me get through the complications of my diseases. I have heard endless horror stories from friends of what nightmares they have experienced from Discovery, however had not until now experienced one of these. I must add that at the moment in my most dire need for the support from Discovery I am being subjected to the MOST horrendous treatment by the Medical aid.
On the 3rd January I had the misfortune of being rushed to Constantaiaberg Medic clinic with compromised breathing and what was presenting as pneumonia. Having called my GP to let him know I was heading to the Hospital and that I needed to see the Pulmonologist, he informed me to go straight to the reception and get checked into B Ward where the Pulmonologist would meet me and take over the course of treatment and get me stabilized. Imagine paying just under R7 000 per month for Medical Aid to have piece of mind that all would be in order when you needed it the most.
When I got to the hospital (who I must add where brilliant and are not at fault here AT ALL). They called Discovery Medical Aid to say I was being admitted under the instruction of Dr Hugh Wegner and that Dr Sean Rogers was on route to the hospital to attend to me.
Discovery at that point asked to speak to me (struggling to breathe) and told me that because I had not physically seen the Dr, I had to go through Emergency to be admitted or they could not get authorization. I informed them that the Doctor had instructed me to go straight to the ward as I am a well-known case and they know what needs to be done and pretty urgently.
Regardless this continued until I was barely breathing put in a wheel chair and taken into Emergency to await the Triage process. When it was completely visible to all parties that I was in distress and my breathing was shortening by the second. Anyone who knows anything about Asthma knows that it KILLS pretty quickly if not managed.
As I waited to be seen in Triage one of the Constantiaberg Claims Manager rushed in to say I was being moved to Ward B18 immediately as Sean Rogers was admitting me.
It then took the incredibly efficient Constantiaberg Staff about 15 to 20 minutes to get me breathing in a stable manner. I was then put up on a drip had a number of tests and had various high-level doses of cortisone, nebulizers, oxygen and meds via drip. During the entire process my sister was with me and bared witness that I was told all was in order and authorized was approved.
I then spent the next 5 days in the hospital receiving high doses of meds, oxygen and physio trying to get my lungs to open up and have some rest. Struggling terribly to breathe at night mostly and coughing up blood. My attending Pulmonologist then sent me for a cat scan to discover there was a mass up in the sinuses which needed to be washed out to clear the constant infected drip onto my chest and possibly get a much greater ease of breathing.
During all this news and the crisis of trying to keep breathing I receive a visit from the Hospital Admin team to say so sorry to inform you (6 days since being admitted and told all was in order) that my pre-authorization had been declined and that I was now liable for all costs until now.
Discovery had approved surgery but that there had been an incorrect admission process and the pre authorisation was still declined. This as you can imagine for a Chronically Asthmatic patient sent the stress levels off the charts and breathing became a challenge again.
In the mean time I have had to have Cat scan as was still not able to breathe and landed up have sinus surgery to try and clear two masses and try clear my airways. This surgery has been approved but STILL discovery reject the initial Authorization.
The BOARD of doctors who work with my complicated case on a daily basis have been fighting endlessly with Discovery supplying them with every ounce of information they require and STILL declined due to a technical glitch.
All the doctors are furious a from my file you can attest to the fact I was admitted by Sean rogers , he has sent all motivations to inform the medical aid how ill I am, and it has done nothing to help the situation. As I type this letter my chest is closing again as I am in distress. I have also been told that due to the nightly coughing spasms I have to undergo another small surgery tomorrow as now it seems the hiatus hernia is pushing through my Diaphragm causing further breathing challenges.
The entire process has been horrendous and at NO STAGE have I the client received any communication from Discovery until yesterday afternoon with NO explanation that the pre-authorization was not approved. Surgery one is approved and now possibly surgery 2 will be approved.
I am currently on disability so have no way of being Liable-for this bill. I believe that there MUST be someone who can help me out there? I need this sorted out or I really do feel that physically my body is going to just shut down.