The Council for Medical Schemes (CMS) has handed down a ruling in the case of a glaucoma patient who took on Discovery Health Medical Scheme when it refused to pay for an implant that was recommended by a specialist.
The implant is of a medicated device called a Xen stent to lower eye pressure.
Wits University social security systems administration and management studies chair Prof Alex van den Heever explains.
It looks as though what they were trying to do was not to pay for a particular treatment that was not in their treatment protocol that they would provide coverage for and this was a medical condition that falls within what is called Prescribed Minimum Benefits.— Prof Alex van den Heever, Social security systems administration and management studies chair - Wits University
The judgment itself is operating in terms of the law, it is not creating law so it is really interpreting existing provisions in a way that is constant with the overall legal framework.— Prof Alex van den Heever, Social security systems administration and management studies chair - Wits University
Click on the link below to hear the full conversation....