Your finance savvy checklist

René Botha gives us an efficient checklist to avoid financial toxicity when undergoing oncology treatment.

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One of the most difficult challenges to navigate following a cancer diagnosis is the financial impact. Often there are so many appointments, tests, and treatments, and the costs can be overwhelming. Medical aids cover many of these costs, however, there may be shortfalls, and you can quickly lose track.

Oncology benefit

The first way to manage oncology costs is to ensure that the oncology benefit is activated with your medical aid. You can do this yourself or your treating doctor may assist you. This is a dedicated amount that is used specifically for cancer treatment-related costs, including tests, radiology examinations, and treatment. 

Each medical aid has its own set of rules regarding how these benefits are allocated so make sure that you know the details of your cover as well as what is excluded so that you can plan around these costs. 

Use network DSP

Some medical aid plans have designated service providers (DSP). This is done to manage treatment costs. Using a healthcare professional outside of the network may incur a co-payment. Ask the doctor before you book an appointment if they are part of the network and if there will be any additional co-payments for treatment under their care. 

Ask for a breakdown of costs

Some medical practices do accept medical aid rates, some have arrangements with medical aids for different rates, and others are not contracted to any medical aids. The practice should be able to advise you in advance whether there will be additional costs. 

Should the procedure or treatment you will be receiving involve other medical professionals, such as pathologists or an anaesthesiologist, enquire ahead of time whether these practitioners are contracted to your medical aid or if there will be additional amounts to be paid. 

Pre-authorisation

Most oncology-related costs need to be pre-authorised. This includes certain radiology examinations, certain tests like biopsies, radiotherapy or systemic therapy, and even supportive medications used to treat pain and side effects from treatment. 

Ask your doctor prior to any tests or treatments if pre-authorisation is needed and make sure that this is obtained. The service provider should be able to provide procedure codes and estimates of the costs prior to undergoing tests or treatment. 

Call your medical aid and ask what portion of the cost they will be covering and if there is any shortfall. If you are unable to cover the shortfall, discuss this with your doctor before undergoing the planned treatment and ask if there are any alternative options. 

Prescribed minimum benefits

Certain tests and treatment should be covered under the prescribed minimum benefits (PMB). All PMB treatments should be covered in full. 

Only a non-DSP co-payment may be applied to a PMB treatment, if you have elected to use a service provider outside of the medical aid network. 

If any test or treatment is short-paid, ask your oncologist or surgeon if this cost is for a PMB. If it a PMB, you may request that the medical aid reprocess the account for payment in full. 

Please be aware that not all tests and treatment fall under this classification and some expenses may not be covered in full. 

Check statements

Check every medical aid statement you receive to ensure that procedures and treatments are paid from the correct benefits. 

Oncology-related costs generally should not be paid from your medical savings account. If costs have been paid from your medical savings instead of the oncology benefit, query with your medical aid if this expense should not be processed from oncology. It may require motivation from your treating doctor. 

Extra cover

Additional insurances, such as dread disease cover and gap cover, may be helpful in covering some of these expenses. If you have either of these policies in place, ensure you know which benefits you can claim so that you may plan accordingly.