I live in South Africa, and we have medical aids, which are more or less the same as private medical insurance in the US. Now, my medical aid limits the hospitals I'm allowed to be admitted to and the doctors I'm allowed to see.
I while back I had hyponatremia with cerebral odema and seizures. My doctor wanted me admitted to hospital as an emergency, but the hospitals I was allowed to go to did not coincide with the neurologists I am allowed to see. So basically, I'm allowed to see Dr X, but Dr X only works at hospital X and the medical aid demands that I go to hospital Y, which Dr Y works at, except that the medical aid insists that I am not allowed to see Dr Y. Ultimately, what that means is that i cannot get a hospital admission for anything epilepsy related, which is clearly ridiculous. What ended up happening when I was ill is that I never could go to hospital at all. The week that followed was the longest of my life.
Furthermore, the medical aid said that if there was a life threatening emergency I was allowed to be stabilised in any hospital on or off their network but that there was only a medical emergency if I was bleeding or unconscious. Now, I was barely conscious--my EEG read as though I was asleep, so I was on the brink of a coma but I was 'conscious'. As you well know, epilepsy related medical emergencies do not always come with unconsciousness--I have been in status epilepticus a few times, during which I was conscious, and yet I would have died had I not been put on a drip immediately.
I haven't come across a cause that I felt was worth my putting on my activist hat for for several years, but I believe that this situation is well worth my efforts and attention. I was wondering if anyone had any advice as to how I would confront this and put pressure on my medical aid. I'm not bothered about sending a personal complaint or the like. I've already gone as far as I can with the medical aid on a personal level. I want to expose this issue in a more targeted way. Any advice?
I while back I had hyponatremia with cerebral odema and seizures. My doctor wanted me admitted to hospital as an emergency, but the hospitals I was allowed to go to did not coincide with the neurologists I am allowed to see. So basically, I'm allowed to see Dr X, but Dr X only works at hospital X and the medical aid demands that I go to hospital Y, which Dr Y works at, except that the medical aid insists that I am not allowed to see Dr Y. Ultimately, what that means is that i cannot get a hospital admission for anything epilepsy related, which is clearly ridiculous. What ended up happening when I was ill is that I never could go to hospital at all. The week that followed was the longest of my life.
Furthermore, the medical aid said that if there was a life threatening emergency I was allowed to be stabilised in any hospital on or off their network but that there was only a medical emergency if I was bleeding or unconscious. Now, I was barely conscious--my EEG read as though I was asleep, so I was on the brink of a coma but I was 'conscious'. As you well know, epilepsy related medical emergencies do not always come with unconsciousness--I have been in status epilepticus a few times, during which I was conscious, and yet I would have died had I not been put on a drip immediately.
I haven't come across a cause that I felt was worth my putting on my activist hat for for several years, but I believe that this situation is well worth my efforts and attention. I was wondering if anyone had any advice as to how I would confront this and put pressure on my medical aid. I'm not bothered about sending a personal complaint or the like. I've already gone as far as I can with the medical aid on a personal level. I want to expose this issue in a more targeted way. Any advice?