Oncology
The Oncology Treatment Programme is a programme to pre-authorise and interact with oncologists with regard to cost-effective treatment plans for patients with cancer. The objective is to optimise a medical scheme's oncology expenditure while ensuring that members receive the care that they need. This includes the referral of patients on State benefit options to private healthcare providers where the service is not available in the State facility, along with the subsequent management of the monetary benefit offered.
The Oncology Treatment Programme includes member education, the pre-authorisation of access to medication and hospital benefits, and the rational and appropriate management of all costs incurred by the affected members.
Case Managers with oncology training and clinical experience handle all pre-authorisation processes. They interact with Metropolitan Health Risk Management's oncology advisors and the South African Oncology Consortium's Utilisation Review Committee where necessary. The programme also facilitates referral to the specialist oncology group to treat the scheme patients on a private out-patient basis should the State not have the capacity to manage these patients.