So I have applied for continuous monitoring for a type 1 patient who has multiple hypos affecting daily living. He is on a top plan of momentum (I have other patients on this plan who fund continuous monitoring). I then appealed and put in a second appeal to their DECLINE.
We have been told in writing that they have declined it a third time but with no reason and that they are withholding their criteria from us.
This is common garden crime!
I say this is bullshit! to put it mildly.
In south africa where we have human rights we have a very progressive legislation and law. We have so much and yet we have nothing. Medical aids keep moving the goal posts and now we don’t even know what they are in this case. NO transparency. NO patient care. NO clear communication.
I believe that there needs to be a tide by both patients and doctors against this kind of bullshit decision and policy. Let me know if you are in and we can go to the ombudsman.