Non approval of reconstruction after Mastectomies

<p><br />Good afternoon</p> <p>As a last resort I am mailing everybody that I can maybe get hold of. I am currently willing to go to the Media/Hello Peter all over.</p> <p>I had a bilateral mastectomy many years back. no for reconstruction you question me like a inmate and decline my Dr's motivation and everytime I ask something we start again with an questioning and belittling set of questions. over and over again.</p> <p>2 things happened the last few years and weeks.</p> <p>1. The one side has formed a rejection on the breast and deformed the breast implant and it is very sour and uncomfortable.</p> <p>2. We were in a bike accident 3 months ago - and the right side torn and the Dr app**** for that also to be fixed while we busy with the Left side since about April 2016.....</p> <p>Then the games started as always, asking more information, questioning me and the Dr, requesting more and more information.</p> <p>2 things out of the whole request was approved the rest decline due to "cosmetic" procedure.</p> <p>After a huge fight and Hello Peter a lady Anrietta Botha at med scheme ( ********** ) was willing to assist and again, question after question, pictures, etc.</p> <p>Then we follow up again, got a call said but lots was approved it will be the last time,...then o sorry now wait a snr person will phone you.</p> <p>Then a mail from a Mr Thitus stating it is cosmetic. Sorry no approval - we rep**** and got NO feedback from him either</p> <p>Then the whole story started over again, explain, beg etc...then this morning a mail..sorry apply for ex gratia...and we know the drill next sorry you income is to high you do not qualify.</p> <p>I wish upon nobody to have no breasts and to walk around with deformed implants for years ....but I do understand because you do not have the personal experience and you work on mails and pictures of deformed woman and discuss said over a desk and look at it that you can say ...sorry not approved.</p> <p>I can promise you one thing should this happen to you, you welcome to phone me I will assist you.</p> <p>Roomers has it that GEMS is in financial difficulties and therefore declining all operations etc. That we can see now. Our money every month is good enough but when you must give back to the patient it is not good enough</p> <p>When you ask pictures and questions to and humiliate a person then it is fine, to face somebody is a different story all together</p> <p>Like I said I am going to go to the media with this, I know of people who had breast reductions and IT WAS NOT HUGE breasts. BUT my deformed breasts after the mastectomies cannot be repaired...now it is cosmetic.</p> <p>I have search all over the internet to get the email addresses of the board without any success - Wonder why?????</p> <p>Would you like to walk around in pain with a deformed reconstruction that pushes up to your chin. I believe you will not. I am 53 not 109. And therefore I believe I may still want to feel like a woman.</p> <p>I am a woman, I am upset because the medical aid fails me, I am humiliated by millions of questions, I am sick to hear we need more information or apply for this and that</p> <p>We on MONTHS now.</p> <p>I need the addresses of the total board as I am going to forward this mail to everybody.</p> <p>I am going to the media as well. I am sore, unhappy and had enough I feel like a beggar for my own woman rights AND THAT IN BREAST CANCER MONTH</p> <p>Hope to hear from you this time around!</p> <p>I am highly upset<br /> <br />From: anrietta ********** />Date: 2016-10-11 9:56 GMT+02:00<br />Subject: FW: C wasserman GEMS bors re****ruksie<br />To: ********** ********** <p><br />Hallo Christa<br /> <br />Jammer vir die vertraging- dit gaan baie dol hier.<br /> <br />Ek het na die uitkoms gaan kyk en dit lyk soos jy gesê het.<br />Hier is die vorms wat jy moet invul en aan die skema moet stuur – al die inligting is op die vorms<br /> <br />Dit sal die gouste en enigste ander opsie wees om die operasie befonds te kry, aangesien dit op die hoogste raad bespreek is op grond van die inligting wat ons tot ons beskikking gehad het. L<br /> <br /> <br />Kind Regards.<br /> <br />Anrietta Botha<br />Specialist Clinical Consultant | GEMS complaints <br /> <br ********** ********** Behalf Of Christa Wasserman<br />Sent: Monday, October 10, 2016 10:04 PM<br />To: anrietta ********** />Subject: C wasserman GEMS bors re****ruksie<br /> <br />Goeie naand.<br />Graag volg ek net weer die uitkoms van die aansoek op<br />Groete</p> <p> </p> <p>---------- Forwarded message ----------<br />From: hercules ********** />Date: 16 August 2016 at 10:29<br />Subject: Re: ME: ********** 81<br />To: Carlo Titus ********** Christa Wasserman ********** <p><br />Dear Mr Titus,<br />I can only describe the service and support we as a family received from GEMS as pathetic.<br />My wife had a bi lateral mastectomy and this operation is for re-construction and not for cosmetic purposes at all. The other issue is that subsequent to this request we were involved in a motorcycle accident and the breast sustained further injuries and GEMS still eefuse ro pay for the reconstruction claiming it to be cosmetic.<br />I am appalled by the degrading fasion in which we are treated by GEMS. You leave me no option but to take my case to the media and womans right organisations and lets see whether they will agree that this is a cosmetic procedure.<br />The treatment which my wife is subjected to by GEMS is degrading and and indicative of a culture within GEMS of ignorence towards womens needs and rights.<br />Kind regards,<br />Hercules Wasserman<br /> ********** 361<br />On 08 Aug 2016 3:17 PM, "Carlo Titus" ********** wrote:<br />Dear Mr. Wasserman<br /> <br />Thank you for your e-mail dated 05 July 2016. We wish to extend our apologies for the delay in responding to your complaint and any inconvenience caused in this regard is sincerely regretted.<br /> <br />FEEDBACK ON COMPLAINT:<br />Kindly be informed that on 01 June 2016, the authorisation was approved by the medical advisor with tariff codes 0334 and 0009 but tariff code 0296 was correctly declined.<br /> <br />The authorisation department erroneously sent a decline letter instead of the approval letter for authorization number ********** 8. The medical advisor confirmed that tariff code 0296 - for strattice graft, was correctly declined. Breast reconstruction surgery does not qualify for funding as per Scheme rules , Annexure E 15.5 – Breast reconstruction, unless subsequent to a mastectomy for cancer and subject to pre-authorisation.<br /> <br />Tariff codes 0334 and 0009 has been approved with authorization number ********** 8 and you may apply for Ex-gratia assistance.<br /> <br />Despite the authorisation department’s numerous attempts to obtain the letter of motivation, the information has not yet received. The query will be closed in the interim.<br />We will be able to review the request for tariff code 0296 (for strattice graft) once the required motivation has been received.<br /> <br />Regards<br /> Carlo Titus<br />Client Liaison Officer<br />Gems Business Unit </p> <p>Tel: +27 (0)21 ********** <br />Mobile: </p> <p><br />Parc du Cap 5, Mispel Road, Bellville, Cape Town, 7530 PO Box 2212, Bellville, 7535 <br ********** /> </p> <p> <br /> </p>