Medshield denying me my mastectomy

MEDSHIELD Medical Aid have denied my request for a preventative double mastectomy but would be willing to pay for chemo and cancer treatments which I have an eight out of 10 chance of getting.

I am taking my plight to the news as many medical aids are authorising these preventive measures.

I have the BRCA1 gene and my chances of getting cancer are 72%.

Every woman in my family, on my mother’s side, has either had breast or ovarian cancer and Medshield, who have received various motivational letters from my doctor and genetic counselling clinic, refuse to authorise the procedure.

Discovery authorises this procedure immediately which they would only do because of the high risk factor. Please can the press intervene and help put pressure on Medshield Medical Aid!

I have been dealing with the medical aid board, who keep on telling me that there will be a hearing, but so far, no joy.

Many thanks for your intervention.

Silindubuhle Mnqeta, of the Council for Medical Schemes, responds:

“Thank you for the enquiry. Unfortunately, the current Prescribed Minimum Benefits (PMB) are diagnosis driven. Therefore, in the absence of a diagnosis of breast cancer, prophylactic mastectomy is not considered PMB level of care where intent is purely prevention of disease in high risk breast cancer patients.

“This procedure will therefore be subject to scheme rules and what the Scheme’s benefit structure allows for patients who are high risk of getting breast cancer.”