Legal conundrum envelopes woman facing blindness
Moira Rodinis (85), who is going blind, is fighting her medical aid to be allowed access to a drug called Eylea that will reduce fluid build-up in her eyes, caused by age-related macular degeneration.
A Sunday Times report notes that in March, she won a long fight for Discovery Health to pay the full cost of her treatment after appealing to the regulator – but then it was back to square one as the medical aid appealed the outcome of her appeal.
At the heart of Rodinis’ battle is seemingly a change in practice at the regulator. Rodinis’ legal consultant and industry experts say that previously the Council for Medical Schemes (CMS) would enforce appeal decisions, even if a second appeal was under way, meaning she would have received her treatment while the second appeal process was pending.
However, this is no longer the case, with CMS spokesperson Grace Khoza saying the council could not enforce rulings if a second appeal had been lodged, in the same way courts do not enforce decisions when there is an appeal to a higher court.
The Sunday Times says her comment contradicts Registrar Sipho Kabane, who has said under oath in legal documents that the council’s interpretation of the Medical Schemes Act is that the decisions of its appeal board must be enforced, even in the face of a new appeal.
Khoza apparently did not respond to requests to explain the contradiction.
Discovery Medical Aid principal officer Nosipho Sangweni said it had agreed to fund Rodinis’ treatments in part, while pursuing its legal rights to have decisions reviewed by the appeal board.
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