Breast cancer survivor and medical aid broker, Joanne Stroebel, shares what needs to happen with your medical aid once you are diagnosed and how a medical aid broker can assist.
Joanne Stroebel (52) lives in Plumstead, Cape Town with her husband. They have two adult sons. She was diagnosed with breast cancer and underwent a double mastectomy, chemotherapy and radiation.
I was diagnosed with breast cancer in July 2019 and through the stress of all the tests and appointments in the coming weeks, the one thing I didn’t have to worry about was my medical bills, because I had a medical aid broker. Me!
First step
The first step to getting everything paid for, is being registered on your medical scheme’s oncology benefit. Most doctors know exactly how to go about this and have staff that take care of it, but some don’t. This is where your broker can assist in making sure all the necessary reports reach your medical aid and the registration is completed correctly. This will ensure that claims are paid as smoothly as possible.
All treatments will also require authorisation. Again, in most cases, this will be done for you, but where it isn’t, your medical aid broker can assist too. Once you start treatment, the last thing you want is to be spending time on calls for authorisation and queries. As medical aid brokers, we have access to staff within the medical schemes that assist us directly, so there is no need to sit on call centre lines.
Finally, any claims that are short paid or paid incorrectly can then be sent to your broker to query on your behalf. If you have gap cover, those unpaid claims can then be submitted.
No extra cost of a medical aid broker
There is no additional cost on your medical aid to make use of the services of a broker. Brokers are paid a legislated 3% of premium up to a maximum of R101,91 per policy per month. There is no incentive for a broker to place business with one scheme over another, so your broker should give you the best plan based on your needs.
Upgrading your plan
With a cancer diagnosis, a plan change may be advantageous and according to the rules of the scheme involved, it may be worth your while to upgrade to a better plan that covers your treatment in the best possible way. Only a licenced broker may give you advice in this regard.
Some medical aids have annual limits on oncology, while others impose a 20% co-payment once an annual amount is reached. These limits and co-payments are only permissible if the cancer diagnosis isn’t a prescribed minimum benefit (PMB). This is where things get really complicated.
Mostly, cancer is a PMB if it hasn’t spread from the organ of origin and then as long as the oncologist sticks to the PMB guidelines of treatment, then everything related to the cancer should be covered in full.
Once treatment is for a non-PMB and outside the treatment guidelines, the claims may not be paid in full. Your broker can assist in reconciling claims and making sure the medical aid has paid what they should.
Inform your broker ASAP
Inform your broker as soon as you are diagnosed and keep them up to date as your treatment goes along. They should be happy to help you along this journey and remove as much stress from the process as possible.
I have learnt a huge amount more about how medical aids deal with claims and couldn’t imagine navigating this minefield without the knowledge and experience that I have (during such a stressful time too!). The bottom line is that you don’t have to. If you don’t already have a broker, then find one that you can build a relationship of trust with and make use of their services. This is the time to be kind to yourself.
Dread disease cover
I was fortunate enough to have dread disease cover in place, so as my cancer was Stage 3, they paid out in full. I haven’t needed to use those funds for medical bills. However, since my finances were secure this reduced my stress and worry and I could focus on my healing.
