newsletter BP Medical Aid Society newsletter Welcome to the third edition of the BP Medical Aid Society newsletter for 2015. It’s hard to believe that we have already reached the last quarter of the year.> MESSAGE FROM THE TRUSTEES October 2015 Spring issue E-mail: [email protected]Website: www.bpmas.co.za We have seen many changes along the way which included bidding farewell to our Trustees, Mr Albert Myburgh and Ms Patricia Dourans. We thank both Trustees for their exceptional service to our members and the Society. At the end of June, we also had to bid a sad farewell to our Principal Officer, Ilse Hartlief, after 10 years of sterling service. Her invaluable contributions to the deliberations of the Board of Trustees are missed. With change comes new beginnings, and we wish to congratulate Ms Dawn Fortune and Mr Guy McGregor as new Trustees to the Board. We look forward to working with them over the next three years. We are in the process of appointing a new Principal Officer and details of the appointment will be shared in the year-end communication. In this issue, we highlight the importance of updating your contact details and provide advice on how to avoid co-payments on medicines. October is Breast Cancer Awareness month, and we would like to pay tribute to our members who have faced this battle with bravery and encourage all female beneficiaries to have themselves tested. We trust that you will make use of the preventative benefits offered on the early detection benefit. We wish all our members continuous good health for the remainder of the year and beyond! In this issue ✦ Message from the Trustees ✦ Updating your contact details ✦ Co-payments on medicines can be hard to swallow ✦ Understanding Breast Cancer
Transcript
newsletterBP Medical Aid Society newsletter
Welcometo the third edition of
the BP Medical Aid Society newsletter
for 2015. It’s hard to believe that we have
already reached the last quarter of
the year.>
MESSAGE FROM
THE TRUSTEES
October 2015 Spring issue E-mail: [email protected] Website: www.bpmas.co.za
We have seen many changes along the way which included bidding farewell to our Trustees, Mr Albert Myburgh and Ms Patricia Dourans. We thank both Trustees for their exceptional service to our members and the Society. At the end of June, we also had to bid a sad farewell to our Principal Officer, Ilse Hartlief, after 10 years of sterling service. Her invaluable contributions to the deliberations of the Board of Trustees are missed.
With change comes new beginnings, and we wish to congratulate Ms Dawn Fortune and Mr Guy McGregor as new Trustees to the Board. We look forward to working with them over the next three years. We are in the process of appointing a new Principal Officer and details of the appointment will be shared in the year-end communication.
In this issue, we highlight the importance of updating your contact details and provide advice on how to avoid co-payments on medicines. October is Breast Cancer Awareness month, and we would like to pay tribute to our members who have
faced this battle with bravery and encourage all female beneficiaries to have themselves tested. We trust that you will make use of the preventative benefits offered on the early detection benefit. We wish all our members continuous good health for the remainder of the year and beyond!
In this issue✦Message from the Trustees
✦Updating your contact details
✦Co-payments on medicines can be hard to swallow
✦Understanding Breast Cancer
Your medical aid cover is important to you and your family >
2 October 2015
Your medical aid cover is important to you and your family, especially in times of crisis, and not having meaningful information on hand when you need it can impact badly on you and your loved ones. You can help us to communicate effectively with you, and keep you abreast of important information that may affect your membership and benefits, by ensuring that we always have your latest contact details.
Updating YOUR contact details
You can log in to the Customer Online feature on the BP Medical Aid Society website at www.bpmas.co.za, using your membership number and secure pin to view and update your contact details. If you have not previously registered for a PIN, just follow the prompts and we will send one to you.
Once you have logged in, click on ‘Communication Details’ to update your telephone, cellphone, fax, e-mail and postal address information. Remember to click ‘save’ at the bottom of the page when you are done. Any updates to your ID number and banking details should be done via the Client Services Department.
If you do not have access to the Internet and you are not sure whether or not we have your latest contact details, feel free to give us a call on 0800 001 607.
You can also send us your new contact information by e-mail to [email protected] or by fax to 021 480 4969.
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4 October 2015
Co-payments on medicines can be hard to swallowWhy are there co-payments on medicines? Is the pricing incorrect? Is the pharmacy charging an additional fee or too high a fee? Do I not understand the system clearly? In this article we aim to answer these questions.
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October 2015 5
Continued overleaf >
The price of dispensed medicine is calculated using the following formula:
In the following examples we examine the most common scenarios that would result in you having to make a co-payment and how to avoid them.
Make use of generic medicine instead of brand-name medicine
What is generic medication?
Manufacturers or pharmaceutical companies invest a lot of money and time in the research, development and testing of new chemical entities which results in the high cost of branded medication. The said manufacturer has exclusive rights to produce this medication for a period of time (patent). Once this period has passed, the manufacturers of generic medication can re-produce this medication by means that may be less expensive than the initial company that produced it. The ‘copy’ of the branded medication is then termed a generic. These products will have the same chemical entity or ingredient and have the same strength, dosage form, quality and performance characteristics, and used for the same indications as the branded medicine. The only differences are that generics may look different and cost less than branded medication.
The scenario below may make it clearer:
Mr X received a prescription from his doctor for ABC medicine to treat his high blood pressure.
On presenting the prescription to the pharmacist he was told that he will have to pay R123.45, as his medical aid will not fund the full amount.
There are several factors that could give rise to this situation, the most common of which is that ABC medicine is more expensive than the reimbursement rate set by the Society for similar medicines that are used to treat high blood pressure.
The remedy: Either ask the pharmacist to give you the cheaper medicine so that you do not have to pay anything or choose the more expensive one and agree to pay the difference out of your own pocket.
the price of dispensed medicine
Cost of the product
+ = the dispensing fee charged by the pharmacist
Make sure the pharmacy charges you correctly
If the pharmacy is a DSP pharmacy and Mr X is told by the pharmacist that ABC medicine will be fully paid by the Society, but he is still asked for an additional amount when he gets to the till, this usually means the pharmacy is charging incorrectly.
The remedy: You need to call the Client Service Department on 0800 001 607 or +27 21 480 4610 and confirm that the pharmacy is in fact on the network and has given you the correct medicine to ensure there is no co-payment. Once you have established this, you need to report the pharmacy for incorrect charging and request that the overcharge is refunded.
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Co-payments on medicines continued >
Make use of a designated service provider pharmacy
In the second scenario, the price of ABC medicine is correct and the Society will cover it in full, but the pharmacy Mr X has gone to is a non-designated service provider (DSP) pharmacy and is charging more than the dispensing fee agreed upon with the Society (remember Clicks and Dis-Chem have been appointed as our DSP pharmacies).
The remedy: If you don’t want to pay anything extra out of your pocket, you can negotiate with the pharmacist to charge a lower dispensing fee. Alternatively you can go to a DSP pharmacy where they will charge the lower dispensing fee that was agreed upon with the Society.
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6 October 2015
October 2015 7
Make sure the price the Society covers is still the same
ABC medicine has in the past always been fully paid by the Society, but suddenly Mr X is asked to make a co-payment.
The remedy: The reimbursement rate set by the Society has probably been reduced because new, less expensive generic medicines are now available. You must confirm this with the pharmacist and then decide if you want to change your medicine to one that the Society will fully fund, or you must agree to pay the difference and continue with your current medicine.
Motivate why you need to take a specific, more expensive medicine
If Mr X has tried several alternative, less expensive medicines, but has had bad side-effects or if the alternatives hadn’t worked, he might be able to continue on ABC medicine and not pay anything extra.
The remedy: You must ask your doctor to motivate why you should continue with ABC medicine. Ask him or her to submit the motivation to the Society’s Medicine Risk Management Department on your behalf. If your doctor can’t or would prefer not to contact the Society, but instead gives you the motivation, call the Client Service Department on 0800 001 607 or +27 21 480 4610 and agree on how best to submit the motivation for consideration.
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Always go to a DSP pharmacy where they will charge the lower dispensing fee
8 October 2015
October 2015 9
To commemorate Breast Cancer Awareness month, the Society encourages female beneficiaries to utilise the preventative cancer screening tests offered by BP Medical Aid Society. A list of all preventative cancer screening tests for both male and female members is provided at the end of the article.
How do cancers start?
Our bodies are made up of trillions of cells. You have different cells for different parts of your body – for example skin cells look and work differently from liver cells. Each cell contains DNA, which instructs the cell how to look and behave.
Sometimes, our bodies need to make new cells to replace old ones or repair damage. To do this, a cell makes an extra copy of all its DNA and then splits into two new cells. This process can happen many times over and many cells can be doing this at any one time.
Normally when a cell splits, a number of checks happen to make sure that the DNA has been copied correctly and the new cells have everything they need to work properly. If a mistake is found, the cells die.
However, if these safety checks fail, the new cells may survive with mistakes in them. Sometimes, a mistake in DNA (known as a mutation) might not cause any problems. However, sometimes the mistake can make the new cells behave strangely, splitting into more abnormal cells at a fast rate, forming a tumour.
Not all tumours are cancerous. If the tumour cells don’t have – and are very unlikely to gain – the ability to grow into neighbouring tissue, they are called benign tumours. Benign tumours often don’t need treatment and are not cancerous.
However, if the tumour cells have the ability to invade neighbouring tissues, they are cancerous.
What are the symptoms of breast cancer?
In its early stages, breast cancer usually has no symptoms. As a tumour develops, you may note the following signs:• A lump in the breast or underarm that persists after your
menstrual cycle. This is often the first apparent symptom of breast cancer. Lumps associated with breast cancer are usually painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt.
• Swelling in the armpit.• Pain or tenderness in the breast. Although lumps are
usually painless, pain or tenderness can be a sign of breast cancer.
• A noticeable flattening or indentation on the breast, which may indicate a tumour that cannot be seen or felt.
• Any change in the size, contour, texture or temperature of the breast. A reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer.
Understanding breast cancer
Being diagnosed with breast cancer is a life-changing experience. It is the most common cancer among South African women. According to statistics, the lifetime risk of breast cancer in South African women is 1 in 33. Breast cancer affects more women than men, but men are equally susceptible and should take note of the information in this newsletter, and pass the information on to all the women they know as well.
Continued overleaf >
10 October 2015
Read further on Understanding breast cancer
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What are the symptoms of breast cancer? Continued>>
• A change in the nipple, such as a nipple retraction, dimpling, itching, a burning sensation or ulceration. A scaly rash of the nipple is symptomatic of Paget’s disease, which may be associated with an underlying breast cancer.
• Unusual discharge from the nipple that may be clear, bloody or another colour. It’s usually caused by benign conditions but could be due to cancer in some cases.
• A marble-like area under the skin.• An area that is distinctly different from any
other area on either breast.
There are two important tests to help you detect breast cancer early:
SELF-EXAMINATION:
Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your hands on your hips. Check that:• They are their usual size, shape, and colour• They are evenly shaped without visible
distortion or swelling.
If you see any of the following changes, bring them to your doctor’s attention:
• Dimpling, puckering or bulging of the skin• A nipple that has changed position or an
inverted nipple (pushed inward instead of sticking out)
• Redness, soreness, rash or swelling.
Step 2: Now, raise your arms and look for the same changes.
Step 3: While you’re at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky or yellow fluid, or blood).
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Cancer screening
100% of agreed tariff, subject to the overall annual
limit (OAL)
Limitations
MammogramsOne per beneficiary per annum
Limited to one per beneficiary per annum aged 40 years and older (benefits for beneficiaries younger than 40 years subject to motivation and prior approval)
Pap smearsOne per beneficiary per annum
Limited to one per beneficiary per annum
Prostate specific antigen (PSA)
One per beneficiary per annum
Limited to one per beneficiary per annum aged 50 years and older (benefits for beneficiaries younger than 50 years subject to motivation and prior approval)
Faecal occult bloodOne per beneficiary per annum
Limited to one per beneficiary per annum aged 50 years and older (benefits for beneficiaries younger than 50 years subject to motivation and prior approval)
Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion and cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage. Follow a pattern to be sure that you cover the whole breast.
Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in step 4.
MAMMOGRAM
A mammogram is an X-ray examination of the breasts, used to detect and diagnose breast diseases. Mammography is the most effective method of detecting cancer at an early stage, before the woman or a physician can feel it.
There are two kinds of mammograms:
1. Screening mammography is used as a preventive measure for women who have no symptoms of breast disease. A screening mammogram usually involves two views of each breast.
2. Diagnostic mammography involves additional views of the breast and is used when an abnormality is found during screening or in women who have breast complaints, such as a breast mass, nipple discharge, breast pain or skin irritation.
It is recommended that women over the age of 40 should have a mammogram once every 2 years.
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BP Medical Aid Society offers the following cancer screening tests as part of the preventative benefit:
Out-of-hospital preventative screening benefit
Please send claims to:BP Medical Aid SocietyPO Box 5324, Cape Town 8000
If you have ideas for future articles, suggestions for improvements to your benefits, or even if you have concerns you believe other members should know about, we would like to hear from you.
Send your e-mails to [email protected] and look out for our response in the next issue of our newsletter.
