Health Squared client receives go-ahead to undergo crucial operation

On Monday afternoon Sharon Waison of Fourways undergoes an emergency procedure to unblock the dialysis port in her groin so that she can have the dialysis she desperately needs to stay alive.

As if that wasn’t dramatic enough, her family had to take extraordinary steps to ensure the procedure was covered by her medical scheme, Health Squared.

On Friday the Waisons’ broker informed them Health Squared had declined to cover the urgent procedure.

This despite a court order compelling the scheme to cover the medical costs of gravely ill patients such as Waison until the end of the month, pending the scheme’s liquidation application.

The blockage came to light during Waison’s Friday dialysis session at Life Fourways Hospital, meaning it had to be halted prematurely, leaving her in a weakened state.  

On Saturday morning her mother received a call from a Life Fourways employee, stating that Health Squared members were no longer covered by the scheme.

“She said we’d have to pay cash unless we had joined another scheme,” Waison said.

She alerted Mark Hyman, CEO of MediCheck, a company which solves members’ problems with their medical schemes, who took action wearing the hat of CEO of Citizens For Integrity, a non-profit company based in Johannesburg.

On Sunday, Hyman served urgent court papers on eight respondents, including the newly-appointed curator of Health Squared.

“We called for the immediate arrest of Health Squared’s principal officer for contempt of the court order of judge Allyson Crutchfield,” he told TimesLIVE.

That order, made final by the judge just more than a week ago, was hailed as a lifeline not only to Health Squared’s 54 dialysis and kidney transplant patients, but to all members “experiencing grave, life-threatening risks”.

But many healthcare providers appear not to be aware of that order, insisting all Health Square members pay cash since September 1.

“Papers were served soon after noon yesterday [Sunday] on all respondents and Health Squared provided authorisation 10 minutes before the deadline,” Hyman said.

The scheme’s attorneys confirmed the relief sought against the scheme was “no longer relevant” as Waison had received the required authorisation.

And on Sunday night, Life Fourways advised that Waison would be admitted as a medical scheme patient on Monday morning.

Vanessa Waison told TimesLIVE that shortly after checking her daughter in at the hospital on Monday morning she had called her with good news.

“She said, 'Mom, I’m getting five-star treatment.'

“We had a very anxious weekend, but I’m so relieved and grateful that the procedure is going ahead today [Monday]. Now I just need to get her on a new medical scheme.”

Health Squared informed its 24,000 members on August 18 that it intended to apply to the high court for voluntary liquidation as a result of an acute solvency crisis brought about by a rapidly dwindling membership and an above-average proportion of pensioners.

The bombshell news was that the scheme would stop paying claims at the end of August. That gave members just eight working days to find alternative cover.

The Council for Medical Schemes (CMS), which regulates the industry, had been negotiating with seven major medical schemes to take over Health Squared members, but late on August 31 the regulator announced that only a few schemes had committed to the migration concession without underwriting or waiting periods.

That left members to scramble for alternative cover on their own. In many cases, other schemes have sought to impose three-month waiting periods.

On Friday afternoon, the CMS issued a press release announcing the scheme had been placed under provisional curatorship the day before by Crutchfield.

“The CMS brought the curatorship application to examine the actual financial position of the scheme and oversee the liquidation process.

“Mr Joe Seoloane is expected to take complete control of the scheme and attend to all complaints and queries from concerned beneficiaries seeking assistance with their membership. Health Squared members are invited to direct 'all queries, complaints and questions' to Seoloane by e-mail: j.seoloane@gmail.com or phone: 011-796-6425.”

Health Squared may not apply for liquidation before September 27 and remains an active scheme until a liquidation order is finalised.

• GET IN TOUCH: You can contact Wendy Knowler for advice with your consumer issues via e-mail: consumer@knowler.co.za or on Twitter: @wendyknowler.

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