Project Ask: Medical Aid Member
Medical Aid Member
PHASE 1
When you are diagnosed your treating doctor will discuss treatment options with you. Your doctor must explain the various procedures,
and drugs that can be used to treat your cancer and all the side effects they may have. This is called ‘informed consent’ and is a legal requirement.
Together, you and your, doctor will agree on what your treatment will include. This will be your ‘treatment plan’.
Once your treatment plan is agreed upon the process of informing your medical scheme about your condition begins.
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Step 1: Your doctor will submit your treatment plan to your medical scheme for them to agree to pay for the treatment
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Step 2: Your medical scheme will respond to your doctor stating which part of your treatment plan they agree to pay for. This normally takes a few days.
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WHAT HAPPENS NEXT?
The medical scheme can accept the entire treatment plan as is and your doctor will inform you and your treatment can begin.
OR
The medical scheme can decline to pay all or part of the treatment plan. If this happens your doctor can either change your treatment plan or you can challenge the medical scheme’s decision.
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