Dictation of invasive versus NON invasive procedures - where is the logic???

I'm wondering if MediHelp somewhere along the line has missed the fact that there is a WORLD pandemic called COVID-19????

A person going for surgery (not elective surgery but required surgery based on medical expertise) needing to go to ICU after surgery is a patient at risk (I don't need to state the obvious and I should think if the reviewers of authorizations are supposed to be professional and QUALIFIED individuals, they will know this very well.) But maybe my assumptions are wrong and they think they know better than a specialist cardio thoracic surgeon who is recommending that the keyhole surgery would be safer, quicker recovery and limited, to no exposure to COVID-19!!!

Why then is MediHelp willing to cover 100% of an INVASIVE surgery, ICU stay of 5-7 days and who knows how many days after that, at much HIGHER COSTS and more importantly, at a HUGE risk to an otherwise fairly healthy patient, who's membership fees are up to date and are NOT in question????

My circumstances are as follows: I have to have a tumour removed that is causing immense pain and was misdiagnosed over a year ago in the diaphragm area impacting on the lungs and rib cage. My mother has recently been diagnosed with cancer and is currently undergoing Chemotherapy leaving this tumour it is believed as a great risk with a family history now of 2 generations it seems. There are 2 options an invasive option which will end me in ICU for a minimum of 5 - 7 days with a number of days in a normal ward and a long recovery period or alternatively a NON invasive procedure that will end me up being in ICU for only 1 - 2 days, short hospital stay and should be able to get back to normal activities fairly quickly - GO FIGURE!!! You would think???

COVID-19 pandemic, compromised immune system due to surgery, 2 days in ICU great versus 5-7 days in ICU with an invasive procedure and who knows how much longer, well to me the logic is there that it would be cheaper for the Medical Aid all round to get a healthier fit patient in a quick turnaround time, but maybe that's how my specialist (one of the best in the country) and myself think.

But Medihelp feel that they are in the position to DICTATE which procedure I must have or pay a MASSIVE co-payment to have the quicker, safer option.

MediHelp let me tell you, this better be sorted out very, very quickly or you will have a legal battle on your hands.

YOU DO NOT have the right to: 1) overthrow a specialist surgeons decision to do what is best for me in this high risk state we found this country in currently 2) You WILL NOT be paying out a fortune on additional ICU days, that YOU in fact have determined is acceptable for an INVASIVE surgery, that could otherwise be done with less stress and exposure for me as a patient 3) Should this issue for ANY reason at all not be resolved in the best interests of ME the patient (NOT the scheme and in fact the Dr and myself are trying to SAVE the scheme money by going the route we are) then you have definitely under estimated to what lengths I am willing to go to be safe and well again.

Please don't take this as an empty threat. Legal Counsel will be briefed immediately should your decision on the 100% payout on an INVASIVE procedure versus a co-payment for a NON invasive procedure not be reversed. Pay the amount for the NON invasive procedure and everyone will be happier.

Let's do the maths: ICU stay per day - a minimum of R16,000 to R24,000 per day per patient 2 days in ICU maximum - R48,000 5-7 days in ICU possibly more - R168,000 MediHelp is saving a minimum of R120,000 by going the NON invasive way so even your economic argument doesn't stand. This is even before theatre costs and other procedures. There is already a saving that can go towards the use of theatre instruments.

In these trying times, one would THINK yourselves as supposedly a professional organisation in Healthcare, would think a little as to what is right for THEIR patient and what is being recommended by one of the front-runners in surgery in this field, as well as their other patients that may need the funding for more long-term treatment going forward that if I am in a position to recover quickly, will not need.

I trust this will be taken to heart, it has already been placed on FaceBook and other social media can be added and I will not stop to make it available elsewhere if needed. .

This is the best treatment for me under this countries CURRENT circumstances. NOT wasting money

Oh and by the way, if for any reason I am forced to go ahead with the invasive procedure, contract ANY OTHER complications believe me the law suit will grow and I have no intention of letting this go away at all.

I am also the kind of person to give praises where praise is due. So I hope to hear from you very, very, very soon and this can indeed turn into a Compliment from a Complaint.

The ball is now in your court!!!