A breast cancer patient who successfully challenged the Genesis Medical Scheme before the Council for Medical Schemes now finds herself in debt and without medical cover, reports Rapport.
The 51-year-old woman was diagnosed with stage 2A breast cancer three months after joining the scheme last August. The scheme paid for two biopsies and a mastectomy in January, but failed to pay further treatment on the basis that the cancer spread to adjoining organs.
She complained to the CMS that her lymph nodes are not “organs”.
The CMS ruled in her’s favour on 31 May and ordered Genesis to fund treatment.
However, Genesis has now terminated the her membership on the basis of alleged non-disclosure.
The woman had a breast reduction 32 years ago, and her husband allegedly did not declare a prior diagnosis of Bell’s paralysis. Genesis not only terminated their membership, but is demanding repayment of R107 000 in medical claims paid during the membership.
Genesis spokesperson Elmarie Jensen said the matter was sub judice and the fund cannot comment. “I must, however, state it clearly that Genesis Medical Scheme did not in any way act insensitively or heartlessly” in this “unfortunate situation”.
Netwerk24 article – Siekefonds skop vrou met kanker uit ná twis oor chemo (Restricted access)
See more from MedicalBrief archives:
Top court to decide on medical aid information disclosures
Non-disclosure: Doctors should not attack medical schemes for acting