13 – 17 July 2020 “The next UNAIDS strategy must address head-on the areas where we are still lagging, like combination prevention and human rights of key populations, and address the multiple vulnerabilities of adolescent girls and young women in sub-Saharan Africa.” UNAIDS Executive Director Winnie Byanyima, at the opening Continue Reading
The Acting Registrar, Dan Lechutjo led the CMS team in the oral submissions to the Panel. He was supported by Paresh Prema, General Manager of Benefits, Anton de Villiers, General Manager of Research and Monitoring and Nondumiso Khumalo Senior Researcher of Research & Monitoring. The CMS focused on several key Continue Reading
First appeared on BD live by Tamar Kahn Health Minister Aaron Motsoaledi has moved to end a long-running industry row over the extent to which medical schemes are liable for their members’ bills, flighting a set of proposals that appears to appease funders at the expense of patients. Critics say the Continue Reading
MEDIA STATEMENT PATIENT GROUPS LAUNCH AMICUS CURIAE APPLICATION IN WESTERN CAPE HIGH COURT 17 June 2015 CAPE TOWN – On Thursday, 18 June 2015, the application launched by Treatment Action Campaign (TAC), South African Depression & Anxiety Group (SADAG) and People Living with Cancer (PLWC) to intervene as amici curiae Continue Reading
SECTION27 is becoming increasingly aware that some medical schemes try to narrow the scope of the benefit options they offer when it comes to processing claims. This may be done, for example, by mischaracterising claims so that they fall outside benefit options, improperly imposing late joiner penalties and waiting periods, or failing to cover prescribed minimum benefits as required by law. Such practices are unlawful and violate the rights of scheme members who are forced to incur out-of-pocket medical expenses in circumstances where they are covered by their benefit options. In some cases, they may also be prevented from accessing necessary health care.
Our client, IE, has been HIV positive for 20 years and participated in early trials of antiretroviral (ARV) medicines before the conventional treatment regimens became available. As a result of his exposure to various ARV medicines and regimens over an extended period, IE began to develop fatty growths on his back and neck and was diagnosed with ARV-related lipodystrophy. On the recommendation of his physician, IE applied to Bonitas Medical Fund (Bonitas) for authorisation for the surgical removal of the fatty growths on his body.
Bonitas, however, refused to cover the medical procedure on the basis that it considered the procedure to be cosmetic surgery. There was no medical basis for this decision. Bonitas failed to consider all the relevant information before it and mischaracterised the claim as cosmetic in order to avoid its legal obligation to cover IE’s costs. Following SECTION27’s intervention on behalf of IE, the claim was authorised with retrospective effect and IE was reimbursed most of his out-of-pocket expenses.