CMS appeal ruling
Discovery loses appeal on basic-care benefits
Regulator opens door for patients to force schemes to fund treatments unavailable in state sector
In a scathing and precedent-setting ruling against Discovery Health Medical Scheme, the industry regulator has opened the door for consumers to force the industry to pay for treatment not available in state hospitals.
The Council for Medical Schemes’s (CMS’s) ruling follows a case by an eye-disease glaucoma patient, who took the scheme, which is administered by financial services group Discovery’s health insurance arm, on after it refused to pay for an implant of a medicated device called a Xen stent to lower eye pressure as recommended by a specialist.