(Foto: Google Maps)
The parents of two children with severe disabilities are embroiled in a dispute with Discovery Health over the payment of specialized wheelchairs and rehabilitation equipment which, according to medical specialists, is essential for their treatment.
For the families of Marlo Nagel and Siyolise Futshane, the issue is not simply about administration or finances, but about tools that determine whether their children can sit, move and experience a degree of independence.
According to documents compiled by the families’ dispute specialist, Johan Erickson of EH Legal in collaboration with Human & Human Prokureurs, the relevant equipment was prescribed by specialists in both cases as part of the children’s medical treatment.
Marlo (10) has severe cerebral palsy which he acquired during birth. The neurological condition affects his muscle control, posture, balance and movement and he is clinically classified as non-ambulatory; which means he cannot walk independently and is permanently dependent on a wheelchair.
According to Erickson, several specialists are involved in Marlo’s treatment. A neurological diagnosis was confirmed and the need for long-term mobility support was identified. An orthopedic surgeon further found that specialized sitting and posture support is essential to prevent spinal deformity and joint damage.
Jacques Terry, a medical orthotist and prosthetist from LIMS Orthopedic Services, after a clinical evaluation prescribed a specialized wheelchair system for Marlo.
The prescribed equipment includes, among other things, a rehabilitation wheelchair, thoracic posture support, pressure relief cushions and adjustable leg support systems. According to specialists, this equipment is necessary to maintain spinal alignment, improve breathing, prevent pressure ulcers and prevent further orthopedic damage.
Photo for illustration only. (Photo: Pixabay)
The second case in the dispute involves the case of Siyolise (14) who was registered with Discovery Health at birth in 2011.
Siyolise suffers from a congenital neuromuscular and musculoskeletal condition that results in severe mobility limitations. According to Erickson, the diagnosis falls under prescribed minimum benefits for congenital myopathies. This is a group of conditions characterized by muscle weakness, progressive loss of mobility and musculoskeletal complications.
The prescribed treatment includes, among other things, an electric wheelchair, specialized seating systems, pressure relief apparatus and orthopedic walking irons.
However, according to the family, certain claims for this equipment remained unpaid. The outstanding amounts include R97 737.50 for rehabilitation equipment and R132 831 for mobility equipment – a total amount of more than R230 000.
The families argue that the treatment in both cases is clinically necessary and that the diagnoses fall under the prescribed minimum benefits, as determined by the Medical Schemes Act.
Nevertheless, according to the families, the claims were rejected, which means the children are left without the essential aids needed for their treatment and daily functioning.
- Discovery Health has been repeatedly approached for comment. The comment will be updated as soon as Maroela Media receives the response.