Autoimmune Alliance of South Africa

We advocate for people of all ages living with autoimmunity. We are Dr David Epstein, Karin Davidson (IBD Africa) and Catherine McCormack (Arthritis Kids SA)

[Autoimmune Alliance of South Africa @AutoimmuneSA]

@SAMWUMEDhealth @mccormack_cath @ArthritisKidsSA @drkatiewebb How did you escalate the query if you don’t know who the member is? Why must we speed up the process of contacting you? We’re trying to speed up the process of you contacting us!

[Autoimmune Alliance of South Africa @AutoimmuneSA]

@SAMWUMEDhealth we are waiting for a reply to an urgent application. The member, a child with progressive arthritis, is at a risk of a major flare. It’s been two weeks since the doctor wrote to you. Please respond. Ref: 150823QSRHG7 @ArthritisKidsSA @mccormack_cath @drkatiewebb

[Autoimmune Alliance of South Africa @AutoimmuneSA]

@SAMWUMEDhealth @mccormack_cath @ArthritisKidsSA @drkatiewebb Still no word from @SAMWUMEDhealth. The doctor applied three weeks ago and it’s been more than four months since we started this conversation. This is astonishingly poor service.

[Autoimmune Alliance of South Africa @AutoimmuneSA]

@SAMWUMEDhealth @mccormack_cath @ArthritisKidsSA @drkatiewebb @SAMWUMEDhealth, we still don’t have any feedback. Tomorrow marks three weeks since the application was submitted. Please send a funding decision that takes previous related CMS rulings into account. All details in this regard were emailed to the scheme.

[Autoimmune Alliance of South Africa @AutoimmuneSA]

@SAMWUMEDhealth @ArthritisKidsSA @mccormack_cath @drkatiewebb We can’t DM your account.

[Autoimmune Alliance of South Africa @AutoimmuneSA]

@SAMWUMEDhealth @ArthritisKidsSA @mccormack_cath @drkatiewebb We urgently need an answer on the application for Humira submitted on 15 August. This case triggers Reg 15i(c) of the MSA Regs. The detail is included in multiple communications with the scheme - all unanswered.

[Autoimmune Alliance of South Africa @AutoimmuneSA]

@FedhealthMed The decision in application FDH0118237020 infringes on this member’s rights. Her case case triggers Reg 15i(c) of the MSA Regulations. The scheme knows this from past CMS rulings. @CMSCares4u recently asked schemes to be guided by past rulings. Please comply.

[Autoimmune Alliance of South Africa @AutoimmuneSA]

@medihelpsa @CMSCares4u The active CMS complaints against @medihelpsa show that cases are not investigated individually at all. If they were then this member would have her treatment now instead of in 7 more months.

[Autoimmune Alliance of South Africa @AutoimmuneSA]

@medihelpsa re CMS 83153, the arguments used are identical those those from CMS 81933, 81792 & 77612. In all three cases @CMSCares4u ruled in favour of the member & ordered the scheme to fund treatment in line with Reg 15. How many more times must we do this?

[Autoimmune Alliance of South Africa @AutoimmuneSA]

@medihelpsa @CMSCares4u The feedback is @medihelpsa steadfastly refuses to fund treatment despite the medical merits of this case which clearly trigger Reg 15i(c). The CMS will return a ruling in 3 months & the scheme will wait another 3 months and in the end the member will get her treatment.

[Autoimmune Alliance of South Africa @AutoimmuneSA]

@medihelpsa @CMSCares4u @medihelpsa any feedback please? Nothing is gained from making this member wait seven more months. Past CMS rulings provide a clear guide.

[Autoimmune Alliance of South Africa @AutoimmuneSA]

@medihelpsa, please review CMS rulings for 81933, 81792 & 77612. Nothing is gained from making this member wait seven more months.

[Autoimmune Alliance of South Africa @AutoimmuneSA]

Dr Sipho Kabane from @CMSCares4u recently urged schemes to use past rulings as a guide. @medihelpsa simply ignores past rulings and recycles arguments to the detriment of its members. To what end?