One thing you have probably realised by now is how expensive it is to have cancer!! Just arriving at the diagnosis can drain your day-to-day benefits at a phenomenal rate.
First things first
As soon as you are diagnosed with cancer you need to register with your medical aid’s Oncology Programme in order to have access to Oncology Benefits. To register you, or your treating doctor, must send your medical aid the details of your diagnosis and the test results that confirm the diagnosis.
Most medical aids work with designated service providers (the list is quite extensive). If you choose to be treated by a cancer specialist who is not designated they might charge more than the medical aid is willing to pay. Find out from your medical aid whether your cancer specialists are on their list of providers.
Your cancer specialist must send the proposed treatment plan to your medical aid for approval. You MUST wait for approval before starting the treatment.
Making it Last
Many medical aids have simplified their oncology plans by specifying a 12 month benefit to cover chemotherapy, radiotherapy and other treatments prescribed by your cancer specialist and pathology, radiology, medicine and other cancer-related treatments provided by healthcare professionals other than your cancer specialist.
At first glance that amount may seem more than enough, for example Discovery provides R400,000 for oncology benefits on their Executive and Comprehensive plans and R200,000 on their Priority, Saver and Core plans – but this amount can soon be used up! One particular drug for breast cancer costs about R45,000 for the first treatment and about R25,000 every three weeks thereafter!!
So, how do you make your benefits last? Oncology benefits generally run over a twelve-month period. It is vitally important that you find out whether your benefits run from January to December or for 12 months from the start of treatment. If your benefits run from January to December and you are diagnosed a few months into the year you must find out whether you are entitled to the entire oncology benefit and then ask your cancer specialist / oncologist to structure your treatment in such a way that your medical aid oncology benefit will last you until 1 January, at which point the next year’s benefits will come into effect.
If your oncology benefits run for 12 months from diagnosis then you need to have a heart to heart with your cancer specialist / oncologist as there is a real possibility that you could run out of cover.
If you do run out of cover many medical aids will continue to pay but only 80%. You could be required to make a 20% co-payment (or more!). A 20% co-payment on a treatment of R45,000 is R9,000!!
Ask your cancer specialist whether there is a generic for the treatment they are recommending. Some medical aids insist that only generics are used as it substantially reduces their costs. If your cancer specialist does not like to prescribe generic equivalents then ask them whether they can transfer your care to one of the partners who do prescribe generics.
If you are on a low end or entry-level medical aid plan you need to speak to your medical aid and ask them when they will allow you to swap to a medical aid plan that will better provide for your needs. It will cost you more each month but will probably save you a lot of money in the long term.
If you have no medical aid, or a very basic medical aid, you should consider going to the breast clinic at the Helen Joseph Hospital in Johannesburg. Some of South Africa’s leading breast cancer specialists operate out of this facility! Call the Breast Health Foundation on 0860 283 343 for more information.
Written by Heather Pansegrouw