Posted by: Sanet | 2012-01-27

Reduction of Chronic benefits

Hi, Discovery reduced my benefit for Geodon from R1500 to R950. I am Bipolar and also on Epitec and Topamax. I''ve been on Tegretol, Epilim, Camcolit, Risperdal, Seroqual and Abilify previously. I''m really doing well on my current treatment. Discovery declined my appeal for the Geodon and I can''t afford to pay the difference. I informed my Dr today and he let me know via his receptionist that he can''t change my meds and I must continue to fight Discovery. My meds are finished and I would have expected him to put in an effort? Should he not? Should I find someone else, which might take 3 months to get an appointment, or just half the dose? And increase the Epitec, I can still go up to 400mg. I''m at a loss. It feels like he doesn''t want to help me, he doesn''t see the importance of the issue and he doesn''t care. He never responded when I informed his receptionist that I''m going to half the dose. I feel despondent and can just as well give up if nobody is going to help me. I''ve lodged a complaint at the CMS, but what do I do in the meantime?

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Our expert says:
Expert ImageCyberShrink

Very annoying, and it sounds like a foolish decision by Discovery, especially considering your history ofother drugs not helping. I hope your doctor helped by writing a strong recommendayion for the Geodon, in view of your history -- they'd expect him to do so. I consider it part of a doctors ethical and professional obligations to write a strong motivation for the medicine he recommends for you, to your medical aid. Lodging a complaint seems understandable as his response sounds disappointing and inadequate. How abou geting a second opinion from another shrink who might be less apathetic, afer first requesting, as is your right, a copy of your medical records ? Maybe try approaching Dr Bomberg he head honho at Discovery, who seems a sensible guy ?

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Our users say:
Posted by: Sanet | 2012-01-28

Dear Obvious
I don''t think the government is going to pay for my elaborate treatment regime! They will probably also work on formularies, which will even be stricter than the Medical Aids. I am so frustrated, but I have won 2 cases against Discovery in the past 3 years for non payment of claims, so I am slightly optimistic. Discovery think they can get away with murder. 21 days hospitalization will cost them more than to cover my Geodon in full. But they don''t realize that. They are very short sighted. The medications on the formulary was probably used in 1960 already. It is ridiculous.

Reply to Sanet
Posted by: Obvious | 2012-01-27

As soon as we get a national health service everything will be free.(well maybe a little extra taxation)

I just cannot wait!

Reply to Obvious
Posted by: Maria | 2012-01-27

Sanet I''m just as shocked by how Discovery has simply cut benefits for 2012 and if you''ve been following the news at all you will know that there is a lot of public outcry about it. I''m not sure what can be done though... maybe contact SADAG and see if they have any ideas?

Reply to Maria

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