Results 1 to 3 of 3

Thread: Discovery Medical Scheme/Insurance

  1. #1
    New Member
    Join Date
    Sep 2013
    Thanked 0 Times in 0 Posts

    Question Discovery Medical Scheme/Insurance

    Hi, I'm on Discovery (coast to coast + gap cover) but they refuse to pay my Epitec!!! The neurologist wrote a letter to them because out of all the eppilepsy drugs only Epitec works for me. They refuse to pay it and to put is on my chronic. Can anyone assist me on this matter because I'm paying my medical aid + the gap cover + R600.00(Epitec) eash month. I recently had a baby and can not afford the R600 + every month.
    I do not know what to do or who to talk to anymore!!



  2. #2
    Silver Member
    Join Date
    Jan 2012
    Thanked 53 Times in 40 Posts
    Hi Livvy, epilepsy is covered as PMB (prescribed minimum benefits) on any medical aid, you should be receving a generic medication every month, as this is what the peocedure is. Should the generic be not good enough, your doctor should write a motivation and send it to your medical aid who then should authorize it. If they refuse to do so you will have to take it further with them and if again you have no luck then escalate the issue to the council for medical schemes as they regulate the medical aid industry. In the mean time you will be able to get your chronic medication from a government hospital free of charge.
    ---There is no traffic at the extra mile---

  3. #3
    Diamond Member adrianh's Avatar
    Join Date
    Mar 2010
    Cape Town
    Thanked 808 Times in 642 Posts
    What reason do they give for not covering it?
    Get the exact reason, could it be because the plan that you are on doesn'tallow for expensive chronic meds?

    Epitec (Lamotrigine) is indicated for the treatment of epilepsy and is available under various trade names world wide. If the neurologist was prescribing it for off label treatment such as depression then I canunderstand it being an issue.

    Like I said, get the exact reason for them not wanting to pay for it and then decide on course of action from there. My bet is on the fact that your chronic med funds are either depleted or your plan doesn't cover it.
    How easily someone is offended is directly proportional to how stupid they are.
    ~GS Elevator

Similar Threads

  1. [Question] short term medical insurance
    By Naomi0827 in forum Tax Forum
    Replies: 0
    Last Post: 16-Jul-13, 07:23 PM
  2. [Question] neglegence in sending medical bill to medical aid on time, what do we do?
    By polar101 in forum National Credit Act Forum
    Replies: 3
    Last Post: 30-Apr-13, 03:47 PM
  3. Replies: 0
    Last Post: 04-Oct-12, 09:05 AM
  4. Medical Insurance as opposed to a Registered Medical Aid
    By LotteTorkilson in forum Tax Forum
    Replies: 7
    Last Post: 01-Oct-12, 08:04 AM

Did you like this article? Share it with your favourite social network.

Did you like this article? Share it with your favourite social network.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts