Friday, July 24, 2009

medical aid rejects appeal to pay for herceptin

Discovery has rejected the appeal. First they declined to pay for herceptin because i did not surgery. Ok, know that is unusual for breast cancer but there was no primary tumour, only two cancerous lymph nodes, and it was on doctors' advice that I did not have surgery. Had radiation instead.
So my oncologist appealed against the medical aid's decision. Then today I heard they rejected his appeal. Oh, I do need herceptin they say, because i have a high-risk cancer, well, it's aggressive, but they cannot authorise it as a single treatment. I need taxol as well.
Now taxol as far as I know, is another form of chemo. I met a lady in the radiotherapy waiting room who had had it and now had no feeling in the tips of her fingers and on her feet. I had AC chemo and after four treatments, my cancer went away. To the extent that the doctor who did the scan said if I were a first time patient, he would never have known I had had cancer.
So why does Discovery say I need more chemo? I have since had another scan - when my neck swelled up during radiation - which was also clear so why give chemo to someone who has no cancer in them?
My oncologist apparently laughed at their suggestion.
"I am a reporter," I said to the oncology centre. "Give me an appointment with the doctor so that I can get the facts and figures, more than i can get from the Internet, and I will get to the CEO (well, I can try, can't I?) and I will fight for it."
But the onocologist said: don't fight, do nothing, he will sort it out by Monday.
"Between Friday afternoon and Monday?" I said. But we will see.
The Yoga Man says that Dr D, our mutual opthamologist, said that people get illnesses which challenge them - not the illnesses per se, but the way they affect them. And that my cancer has taken away my control and that is what affecting me the most: the ability to control my life.
Oh by the way, this is what taxol is. Gonna read about it now.
PS: Nearly forgot a crucial part of this. Herceptin, well, the 17 treatments I will need, totals to just under a million rand. Even if/when Discovery authorises it, they will pay only 80% and I will need to pay just under R5000 a treatment. Each treatment is once every three weeks and sometimes two treatments fall into one calender month.

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