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Childhood-diseases

Question
Posted by: Phakiso | 2018/06/22

Q.

My daughter was diagnosed with AVSD and "abnormal right Atrium". The right atrium is smaller than the left atrium. Child had sugery "veins/artiries" were swapped

Right "vein/artery" going to right Atrium was swapped with left vein/artery" going to left Atrium. She also had pacemaker implant. Problem is the treating is not designated service provider(DSP) meaning co payments apply from my medical aid. I take her twice a year for periodical checkup for her doctor who is not DSP, I have to pay copayments. Medical aid wants me to change the treating doctor to a DSP to avoid co payments which I understand. The obstacle is that my daughter must go for another operation to close the holes on her heart, the doctor said we must wait until my daughter gets older and also give that right Atrium a chance to grow. Doctor said they left the holes there so that they don't put too much pressure on the right Atrium. Now because the is already a plan in place for treating my daughter I find it hard to change the non DSP to a DSP as the current doctor knows well the history and what must be done. I cannot risk my daughter health. What I want to know is - are the any processes I can follow to compel my medical aid to pay the non DSP in full because of my daughter situation?

Expert's Reply

A.

Paediatrician
- 2018/06/25

You have stated your problem extremely well. As far as I know your best approach now would be to appeal to the Medical Schemes Ombudsman email: complaints@medicalschemes.com or telephone 012 431 0500

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

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