Results 1 to 4 of 4

Thread: Discovery and infertility as PMB - Blood tests

  1. #1

    Default Discovery and infertility as PMB - Blood tests

    Hi All,

    I have been fighting with Discovery for MONTHS to refund me for my bloods I had done at my FS - they were ALL on the list that should be covered by the Scheme since Infertility is in fact a PMB condition. After much contention they say they will now pay for them (after I jump through some more hoops first of course) ALTHOUGH they say they will only pay for ONE SET of each of the tests - I had a number of repeat tests done at various times in my cycle so I wanted to check if they are being underhanded again or if they are within their rights to do this. PLEASE can you all who are familiar with Medical Schemes and their rules and the actual LAW give me some insight here?

    Thanks girls!!

  2. #2

    Default

    Hi Taylor
    Sorry can't really help you with the legal issues, but I'm also with discovery and my entire savings account was depleted with all the blood tests. I was considering going the same route as you but got a bit worried that if I fall pregnant the medical aid must not refuse to pay for certain things because I had fertility treatments. I don't have any information on that. I was just being cautious. Anyway just wanted to ask you if applied for the PMB before you took the tests?
    Me 38 low AMH
    DH 44 morpholgy issues
    TTC 6 years
    ICSI #1 (March 2010) BFN
    ICSI #2 with IVIG (May/June 2010) BFN
    October 2010 Hysteroscopy - all looking good
    ICSI #3 - dec 2010 with intralipids - cancelled - no fertilisation
    ICSI #4 Aug 2013 With intralipids, embryo glue - BFN
    POA - ???

  3. Default

    What i do know of discovery is that they have excluded 'infertility'. Its a broad statement i guess which is part of the issue. My advice is to get the details of the registrar at discovery management. I contacted the registrar at my MA and we are in contact as to what is and what isnt covered. I also get to negotiate and its a bit better than dealing with incompetent call centre ppl (who will just raise your blood pressure and you will get nowhere). Its actually something that they are willing to do at my MA - communication with respectful discussion gets a lot more benefits than bitching to some idiot on the call centre. Good luck haggling
    Age: 39 Unicornuate Uterus, acidic CM , one remaining ovary
    DH 39: Super super sperm!!!!!
    1 x HSG (diagnosed a UU), 1 x Lap 2009 (removed I big ass fibroid and 3 wannabe fibroids plus stage 2 endo); Suprise BFP while waiting for lap : Beta 404 (14/11/2011) EDD: 22 July 2012 ; Dr R V Rensburg; Mcdonald stitch done at 13 weeks; Baby girl lost due to implantation in rudementary horn, left ovary and horn removed with baby
    Half the woman I used to be but with new man by my side Lap x 2 (April 2013) no endo but scarring from baby loss removed;
    Another suprise BFP (ya some weirdness abounds) - 1st beta at 14dpo 158, 2nd beta at 18DPO 1032, 20DPO 2360
    Rebecca Pamela born 23 April 2014........I have a little bull

  4. #4

    Default

    Hi guys,
    Infertility is in fact a PMB condition specifically 902M as described in the Medical Schemes Act of 1998 (available on the Council for Medical Schemes website - see appendix A) that ALL Schemes HAVE to abide by. Do a search on this forum, there are lots of threads by Dot who knows a hell of a lot about this. There is a PMB form you need to fill in for your Medical aid. If you can get your doctor to write a motivation letter stating that due to whatever reason you are classified as being infertile, you should be able to get the fund to do a reversal and get some cash back although they say they will only pay for one set of each blood test/hsg/sperm tests per year. The following blood tests have to be covered by the scheme and NOT from your savings. An HSG and sperm testing is also supposed to be covered:

    a. Day 3 FSH/LH
    b. Oestradiol
    c. Thyroid function (TSH)
    d. Prolactin
    e. Rubella
    f. HIV
    g. VDRL
    h. Chlamydia
    i. Day 21 Progesterone

    Most of the call centre operators have no idea about this and just say that infertility is not covered - end of story. Ask to speak to a specialist consultant immediately and familiarise yourself with the legislation so you can quote directly from it. They may also not know about it (my experience) but if you insist on speaking with someone even higher up you'll eventually reach someone who does. Most medical aids rely on the ignorance of their members so as not to pay for certain things. I say fight for what is legally your right!
    Me: 31, Stage 4 Endo
    DH: 32, 100%
    Married: 5 years
    TTC: 5 years

    IVF #1 (May 2013) Long protocol + acupuncture BFP!!
    18R, 18F, 2T (d3).
    Cryo: 15 x G1 8C (d3)
    19.06: 8wk scan - IT'S TWINS!
    03.10: 23wks - Goodbye our baby girls...

    FET #1 (Jan 2014)
    ET 5x5d morula (slow, day behind) + acupuncture
    BFFN

    On Visanne for 3 months to treat Endometriosis. Good to go!

    IVF# 2 (Jun 2014) (Long protocol + 3wks Femodene - no acupuncture)
    Endoscratch
    6R, 5F, 2T (d3)
    Vitrified: 3 x (d3) [1x G1 8C; 1x G2 8C; 1xG2 6C]
    BFFN (Prog. support issues!)

    FET #2 (Oct 2014)
    Acupuncture x3 months + TCM + Femodene
    Endoscratch
    ET: 30 Oct
    3T (d4) (2x G2 morula; 1x G5 6C)
    Prontogest prog. support (2WW)
    Beta test: 10 Nov

    "You never know how strong you are until being strong is the only choice you have"

Bookmarks

Posting Permissions

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