Johannesburg - An alleged human error has not only cost a Joburg woman gynaecological surgery to stop incessant bleeding causing her crippling pain, but her medical aid membership as well.
The error? Her mother - the primary member of her Discovery Priority Plan - neglecting to disclose that she was on medication known to treat chronic illnesses - which her mother was allegedly not aware of.
On January 1, 30-year-old Joy* (who asked not to be named out of fear of victimisation) started her menstrual cycle. Her period has not stopped a day since then.
She had joined her mother's medical aid in November as she is a single mother to 2-year-old Mya*, and couldn't afford medical aid fees on her salary.
Her mother, Gwen*, filled out the application form to include her daughter and grandchild on her medical aid cover. But, out of ignorance of the medication her daughter's general practitioner (GP) had prescribed earlier, ticked ‘no’ in section 7 of the form where disclosure of medication is asked.
Rewind to July last year. According to Joy, she had been experiencing a “stressful” time at her job in the advertising industry and had difficulty sleeping.
“My GP prescribed a sleeping tablet called Stilnox and a tablet called Nuzak to help with the anxiety I felt. As a typical doctor, he gave me a repeat script for six months. I was not diagnosed with anxiety at any point.
“At that time, I was not on my mother's medical aid. I took out one prescription with the medical aid I was on then. When I joined Discovery, I took out another prescription and it was processed,” Joy told The Star.
On January 29, Joy said her gynaecologist prescribed a pill to stop her bleeding, but after eight days, the bleeding hadn't stopped.
“On February 13, I went to see my gynae and he did a pap smear, as well as a blood test. The results came back showing I had an abnormally high CA 125 (a test to measure the amount of protein - cancer antigen 125 - in one's blood). He advised surgery to remove my right ovary, get sterilised and an ablation (removing the lining of uterus) on February 29.
“But, by the 16th I was in so much pain I could barely walk,” she said. While at Life Carstenhof Hospital to check in last Tuesday, Gwen called her medical aid to get authorisation for her daughter to be admitted and for the procedures.
“They said it would take eight hours for authorisation, yet my daughter was lying on a concrete bench in pain. Then they said the gynaecologist needed to call their board to motivate the procedures, which he did,” Gwen stated.
But then a Discovery consultant called back informing them that not only were they not going to authorise the surgery, but they were terminating Joy and Mya’s membership for failing to disclose that she had been on medication on the application form.
Discovery Health reputation manager Khensani Mthombeni explained: “The rules of the Discovery Health Medical Scheme (DHMS) require that a membership be terminated where a member has failed to disclose a pre-existing medical condition on their application form.”
Mthombeni added: “Claiming that the person who filled in the form was not aware of pre-existing conditions is not a valid reason for non-disclosure.The law does not allow the implementation of penalties.”
Gwen, sobbing, said: “My daughter needs emergency surgery. She is at home in excruciating pain. I didn't know I had made a mistake. I didn’t know.”
*Not their real names