FA News – 18th Jan
Being diagnosed with cancer is devastating for patients and for family members alike. Often the amount of information received and care required is huge, and it can be difficult to know where to start.
Adding to this, the challenge of navigating state healthcare should you or the patient not have medical aid, as well as the extra stress of wondering how you are going to fund treatment. Even with medical aid, there are often shortfalls involved, and both patients and their carers are left feeling completely overwhelmed.
Luckily, there is support available, through initiatives like the Machi Filotimo Cancer Project. Evy Michalopoulos, Founder and CEO of the Project, shares her story: “I started the project in memory of my late mom, who passed away from ovarian cancer on World Cancer Day, 4 February 2018. She was a two-time breast cancer survivor, but her third cancer diagnosis was a complete shock, as she had no noticeable symptoms prior to falling ill on 27 December 2017, and she passed away just six weeks later.”
“Our challenge was that my mom did not have medical aid or gap cover, so she was moved to a state hospital. I then had to figure out how to get her the palliative care she needed, I did not know who to contact, and in addition I had to find care for a bed-ridden patient, on top of concerns about how I was going to pay for all of this. It consumed my life, and as a result I was not able to take those last few weeks of her life to actually spend quality time with her.”
“This is how Filotimo was born. I wanted to create a hub and a house of hope to help make the journey easier for everyone involved, so we have brought together everyone from top oncologists and medical professionals, nutritionists to sports therapists, psychologists, fertility experts, palliative care-givers and cancer champions to help guide people and change their journey in the most positive way.”
“A huge part of my journey with my mom revolved around how to pay for treatment. The reality is that medical challenges are a huge part of any cancer journey, and without medical aid, and then gap cover to help fund the shortfalls, the financial burden can be crippling. Patients may not be able to receive life-saving treatment because they can’t find the money. This is why we have partnered with Turnberry, to help create awareness of the need for gap cover before a dread diagnosis like cancer occurs,” she says.
Filotimo is a vital support system to help people cope with a devastating diagnosis, and part of the project is partnering with organisations like Turnberry to create greater awareness. The reality is that even with medical aid, benefits are often not covered in full. This includes shortfalls on surgeons who are not in the medical scheme network, as well as co-payments once oncology benefits are depleted, and new drugs like biological cancer drugs and immunotherapy are not covered in full by medical aids. Gap cover then becomes vital in helping to fund the shortfall to make these treatments more affordable and available to patients who need them.
“When new drugs come onto the market it can be revolutionary in terms of treatment outcomes. However, these new treatments come at a premium cost. One example is an immunotherapy drug called Keytruda, which is currently only covered on the highest medical aid plans from certain providers, and then only up to 70% of the cost. There are significant co-payments involved from the start, which makes it unaffordable for many,” says Tony Singleton, CEO at Turnberry.
“Even with gap cover, the full shortfall of these treatments often cannot be funded, because gap cover providers are subject to legislated overall annual limits. To help patients more effectively fund this type of treatment, Turnberry has designed the Innovative Cancer Drug Cover benefit for 2022, which allows for a claim of up to R10 000 per event up to the overall annual limit, helping to cover co-payments from the start,” he adds.
When it comes to cancer, knowledge is power, and having a support system in place can help to ease some of the burdens of the journey. Filotimo and Turnberry are working together to create more awareness around the need for medical aid and gap cover, as well as what type of cover people need to best suit their current life and situation before they become ill.
What is Gap Cover?
I have been a Turnberry Management Risk Solutions customer since 2016, after my financial advisor encouraged me to take out a gap cover plan to bolster my medical aid hospital plan. My plan gives me up to 600% cover for medical scheme shortfalls, which was a real blessing when I was diagnosed with a double pulmonary embolism in August 2020. I was in hospital for five days and saw numerous doctors. I had many tests done including x-rays, CT scans and MRIs. When I was discharged, the bills started to arrive, and each doctor had shortfalls that my hospital plan would not cover. Luckily, I had gap cover in place, and Turnberry took care of these shortfalls so that I could focus on my recovery. This was the first time I had claimed from my gap cover, but the relief of knowing that I had cover took away a lot of stress. My broker took me through the process and once I submitted all of the required documents, the claim was assessed and paid out within a few days. I then had to have a follow-up MRI with a co-payment which was not covered by my medical aid, and Turnberry again came to my aid. Going from healthy to hospitalised is not something you expect, but in reality, it can happen to anyone, and the last thing on your mind is how you will pay for the bills. I learned this the hard way when my mother was diagnosed with cancer and did not have medical aid or gap cover, and the financial pressure of trying to fund her treatment was enormous. This is a burden nobody should have to deal with, which is why gap cover is absolutely essential.
Evy Michalopoulos, Founder & CEO of the Machi Filotimo Cancer Project – November 2021