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WCLawyer, Attorney
Category: South Africa Law
Satisfied Customers: 15603
Experience:  L.LB (UOVS)
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My daughter has had a coil put on to her heart at 7 months

Customer Question

My daughter has had a coil put on to her heart at 7 months at 12 they found that she had marfans syndrome at 13 they found out she had scoliosis because of the marferns.We applied for the brace through our medical aid and the medical aid approved it knowing full well that she had to have a brace until she stopped growing,after 2 years she needs a new brace which they now refuse.The spine cuve has improved alot due to the physio and the brace as well as the exercises but since the brace has become small and we cannot get the brace its definitely affecting her as her back started paining.please help
Submitted: 1 year ago.
Category: South Africa Law
Expert:  WCLawyer replied 1 year ago.

Good Morning

If the issue is the medical aid refusing to pay for another brace despite their policy contract stating that they must, then you can refer the matter to the Medical Schemes Ombud.

It is a free service where the ombud will make a decision based on your representations and that of the medical aid on whether the medical aid is obligated, in terms of their contract with you and in terms of the various pieces of legislation on medical aid schemes applicable.

The link I provided will provide you with contact details of the ombud and access to their website, where you will find a brief explanation on how to log your dispute.

I hope this helps you a little bit, but if you have follow up questions before you rate, feel free to ask them at no extra cost. If you are satisfied with the service, kindly rate it positively.

Expert:  WCLawyer replied 1 year ago.

Apologies. Here is the link to the complaints process.

Expert:  WCLawyer replied 1 year ago.

I sincerely ***** ***** your daughter gets the medical assistance that she needs.

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