In a statement received from Discovery, Dr Jonathan Broomberg (CEO Discovery Health Medical Scheme) said that the scheme “provides cover for spinal surgery according to the benefits of a member’s specific plan type. As spinal surgery carries significant risks and should only be done where appropriate, these benefits are also subject to defined clinical guidelines, which are developed in consultation with leading spinal surgeons in South Africa. This ensures that the guidelines take into account the latest available published evidence and the best available local and international expertise, including the risks and benefits for patients from this type of surgery.”
With regard to the Smith’s case he said, “The initial request for funding for the spinal surgery using the interspinous device was declined, as Mrs Smith did not meet the criteria as per the Spine Society Guidelines. This does not imply that any spinal surgery was declined, but only the use of this specific device.
Subsequently Mrs Smith consulted a new doctor to obtain a second opinion, and late last week, Discovery Health received further detailed clinical information. This updated information was submitted to the SA Spine Society, which confirmed that the patient will benefit from spinal surgery in terms of the Society Guidelines.
This was not the case based on the prior information. Based on this updated information, we have indicated to the member that the spinal surgery will be authorised immediately.”
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