Irritated

Back to work for me today. This morning I had to get an authorisation for a patient to have a breast reconstruction. She is a member of my favourite medical aid, Dico.very. I think I’ve explained this all before but cancer is what is known as a PMB condition and the medical aids have to pay for any procedures related to the cancer. Chris is contracted to Disc.overy which means he has to charge the rates they prescribe and the patients don’t have to pay any additional costs (such a nice guy). Anyway, I give the call centre lady all the codes and details and then can hear her discussing the case with whom I presume was her supervisor. The lady had her mastectomy last year and the plan is to do a muscle flap, an implant and then later on one does symmetrising surgery for the other breast and a nipple reconstruction. They are obviously querying the muscle flap part of the operation and going on about doctors charging for extra unnecessary things and not doing the op within 3 months, etc., etc. Now I’m clearly not a plastic surgeon but neither are they. The reconstruction is not always done within 3 months because often the patient is still having radiation and radiation can be catastrophic for wound healing so one needs to wait for the radiation to be completed. When they do the mastectomy (I’m sure you’ve all seen photos) they remove the breast with the skin and then stitch it closed. If you now come along and try to put in an implant, in a few patients with small breasts the skin can stretch, but for most women there is not enough skin and so they need to do a flap in order to get enough skin so that the implant can be put in. You need to take the skin with some underlying muscle tissue or else the skin will die and it all helps to give a more natural result. Bear in mind the other side doesn’t get an implant so even I can imagine how unnatural it would look if your one breast was just entirely implant and the other was a normal, middle-aged breast.

Chris had written a letter of motivation which I had to fax through but it just made me so irritated thinking that these people were chatting about whether the procedure was necessary or not. As soon as one hears the reasons or sees the photos it becomes blindingly obvious. Breast cancer is unfortunately very common so this can’t be the first breast reconstruction they are dealing with. Why are they always looking for reasons to say no?

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3 Responses to “Irritated”

  1. darylfaure Says:

    Horrid bureaucrats – may they never have to fight the same fight.

  2. Sam Says:

    It also annoys me big time – we ended up having to shell out an additional 27K for Kade’s birth cos it was an unplanned c-section…and when I tried to fight it they gave me so much hell about it… *sigh*

    Stupid assholes!

    xxx

  3. cat@juggling act Says:

    Oh I have to agree fully.

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