Code of Practice

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Posted: 2017-12-07 15:42

There are several different kinds of health insurance. Traditional insurance often is called a “fee for service” or “indemnity” plan. If you have traditional insurance, the insurer pays the bills after you receive the service. Managed care plans use your monthly payments to cover most of your medical expenses. Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the most common managed care organizations.

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Changes have recently been made to America's health care industry, via legislation passed by Congress. With 7,555 pages of legislation that even the lawmakers failed to read, America's health care bill, dubbed "Obamacare," has become one of the most difficult things to understand in recent history. However, understanding the "gist" of how this legislation works will enable people to make crucial decisions about their and their family's health and other expenses.

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There are many excellent public hospitals and superb academic cancer specialists who work in government hospitals. As with all times of illness: knowledge is power, therefore knowing what management you should be expecting will help you navigate through the system. Books, magazines like this one and the internet can help you get more information to help you in your journey. There are many organisations that wish to help patients who do not have the resources for travelling to a hospital or managing treatments.

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For a comprehensive directory of available patient-assistance programs (including which programs offer which drugs), visit NeedyMeds. Some programs run by pharmaceutical companies require your physician or another advocate to register you. If your doctor isnt available to help and you need someone to act on your behalf, or if you just need some help with the paperwork, NeedyMeds can direct you to an advocate in your area.

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All medical aids, even hospital plans, have to provide some cancer cover. This will include in-patient care but may also include specialist fees, chemotherapy and cover for radiation and medications. The amount and type of treatments covered tends to depend on the medical aid plan that you are on, and it may require you to register for a cancer scheme after diagnosis. Check when you are considering starting or changing medical aids what type of treatments you are covered for. Fortunately medical aids are not allowed to refuse cover for a patient with a pre-existing condition and that includes cancer. Remember to always mention these conditions to your medical aid so that you gain access to appropriate care and do not disqualify yourself.

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There is also a strong connection between many public breast units and Breast Health Foundation of South Africa, with counselors available to guide and support patients through diagnosis, treatment and recovery, allowing for seamless care and follow-up. It is easy for patients in our time- and economically-constrained community to ‘fall through the gaps’ of cancer treatment, and the counselors form an important safety-net to prevent this.

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In private you can see the specialist the next day where as in public the clinic may only run once or twice a week. Other than this, breast specialists believe patients should have access to exactly the same standard of healthcare in public and in private: the same expertise, the same research trials, the same support groups and psychological care for cancer survivors. And all oncology specialists strive for this.

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The problem is that clinics which do not have specialist-based supervision often result in inappropriate patient management. This is not just a problem of an under-resourced state system but the same for public and private surgeons. In order to be really good at something, whether it is driving a car, raising a family or managing cancer, you have to practice. Every mother can tell you horror stories and mistakes she made when she was a new mum. But over the days and years she has ‘seen it all’ and knows how to deal with every mood and every tantrum her children can have. It is the same with breast cancer: with the more patients you see the unusual becomes usual and nothing can surprise you. That means you are better at dealing with all the many faces cancer can have. That is what makes a specialist and why specialist units tend to manage patients in a more holistic way.

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Unlike a normal high-risk pool, where individuals needing insurance for health reasons would share similar packages, a group coverage pool is simply an efficient way for people with something in common-in this case an employer-to pay into a health care package. Group pools usually cost less since they're not risk-based however, not every individual in the pool pays the same rate. Premium prices are dependent on age, location, preexisting conditions and other factors, even though the insurance package will be relatively the same.

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