When it comes to serious medical conditions, isn't it reassuring to know that we're here to help and support you? We're not talking about paying for claims - that's a given. We're talking from a cost management, treatment monitoring, advice, and support point of view across all CMP plans.

Introducing Medical Case Management (MCM)

In the interest of preserving your funds, we have taken it upon ourselves to choose and negotiate with service providers to ensure that you receive the best possible service and treatment. It also means that we're actively involved in managing your condition and helping to make difficult decisions.

Our involvement goes a long way to alleviate stressful situations by:

• Managing your stay in hospital
• Monitoring your level of treatment and care
• Continuously liaising with your doctor, the hospital and your family
• Offering emotional support and counselling for you and your family
• Conducting independent assessments of treatment plans to ensure they are medically correct for your condition, age profile and medical history
• Pre-approving procedures to allow for peace of mind while you're in hospital
• Advising on medical conditions

Our programmes

We employ trained medical professionals to manage our MCM division. In addition to managing conditions like cancer and HIV/AIDS, MCM runs two dedicated programmes:

• Mum's the Word: a maternity programme for expectant mums. At no extra cost, mums who register obtain access to a range of resources and benefits. Call 0860 100 512, or email mumstheword@cmp.co.za.
• Chronic Disease Management: this programme involves the management of all chronic diseases and medication. If you are diagnosed with a chronic condition, you will be required to register annually with our programme to access Chronic Medicine Benefits. Call 0860 100 512, or email mcm@cmp.co.za.

The bad with the good

The job of a case manager is seldom easy. There are times when treatment is denied with very good reason - most often when medically futile. The situation is magnified by the emotional circumstances that surround illness, making the decision by case managers even tougher. Remember, we have the interest of all Scheme members to consider when authorising costly treatment. MCM thus protects your access to available funds, as well as the Scheme's long-term sustainability.

MCM in action

• In one incident, a member requested hyperbaric oxygen treatment to fast-track the healing of a surgical wound. MCM denied the request and soon after, the wound healed on its own, saving the member and the Scheme money.
• Another member also requested hyperbaric oxygen treatment which was denied by MCM on medical grounds. When insisting the treatment was part of PMBs, MCM followed up with doctors only to find that treatment was not prescribed by the doctor at all.
• In another case, MCM recommended a terminally ill patient return home from hospital when treatment was no longer being administered. CMP paid for home nursing in lieu of hospitalisation, enabling huge cost savings for the member and the Scheme. Although the patient died three months later, she was comfortable in her home surroundings, and received care on par with hospitalisation.
• "After major back surgery, I was so stressed out regarding the cost but in too much pain to do anything about it. Can you imagine the relief when I got CMP's first payment advice to find that everything had been covered, except for the corset I have to wear? Dealings with MCM were an absolute pleasure and handled in a totally professional but warm manner." - Margie Hutchison, CMP member.
• "I wish to thank and commend you for the efficient and heartfelt manner in which you dealt with my wife's recent terminal cancer case. For Sister Paola and all the ladies in Customer Care, nothing was too much trouble." - CMP member.

Beneficiary ID numbers:

For audit purposes, we are required to update all beneficiary names and identification numbers, including those of newborn babies. All members are requested to forward this information to us as soon as possible. Thank you to those members who have already obliged.

Changed banking details?

You are required to fill in and submit a change of banking details form, obtainable from our Customer Care division. You will also need to furnish us with a copy of your bank statement as confirmation of your details. No other means of communication will be accepted. Note: please be specific when filling out your form. In most cases, we file two sets of banking details per member - one for debit orders, and one for member refunds. Please ensure both are correct.

Cancer affects hundreds of men and women every year. And while there is sometimes little that can be done to prevent certain cancers, the most effective weapon is spotting early warning signs and applying an appropriate course of treatment as soon as possible.

Just like women are more at risk of developing breast cancer, for example, there are certain cancers that men should also be aware of.

Prostate cancer

The prostate gland is located beneath the bladder in men. While the causes of prostate cancer are still unknown, men are at greater risk of developing it as they age. Genetic factors also play a role in the development of prostate cancer - men who have had a blood relative with prostate cancer are more likely to develop it themselves.

Symptoms to look out for include:

• A painful sensation during urination
• Lower back pain
• Frequent urination at night
• Blood in both urine and semen
• Difficulty urinating

Prostate cancer has very few symptoms in its early stages, making regular screenings of the prostate gland vital.

Colorectal cancer

Colorectal cancer develops in the colon and rectum, which are both part of the long intestine. Colorectal tumours can be either benign or malignant.

Even when tumours are benign, they should still be removed as they can become cancerous over time. Removal of benign tumours can be performed during a routine colonoscopy, which can also help diagnose any malignant tumours.

Genetic factors and diet play a role in the development of colorectal cancer, and symptoms include:

• Changes in bowel habits
• Chronic fatigue, and
• Worsening of existing bowel disorders

Lung cancer

Unlike some other cancers, lung cancer has a particularly high fatality rate and smoking is the most common cause.

Symptoms of lung cancer include:

• A persistent cough
• Blood-stained sputum
• Poor appetite
• Weight loss
• Fatigue
• Prolonged hoarseness and/or a sore throat

Skin cancer

One of the most common forms of cancer, skin cancer is highly treatable if detected early. Melanomas are malignant tumours of the melanocytes in the skin, and may cause the cancer cells to spread throughout the body if left untreated. Treatment for this form of cancer is the surgical removal of the malignant tumours.

Treatment options

There are various ways in which to treat different types of cancer, some more invasive than others. Traditional treatment options include:

• Radiation therapy, which uses radiation to destroy malignant cancer cells. It can be used to treat a variety of cancers, including prostate, testicular and early-stage lung cancer.
• Chemotherapy, an aggressive approach that uses chemicals to destroy rapidly dividing cancer cells. Although effective in some cases, chemotherapy can also harm naturally occurring, rapidly dividing cells in the human body. This is what causes the awful chemotherapy side effects.
• Surgery, which is recommended in the treatment of skin cancers, and when the immediate removal of a malignant tumour is necessary.

You never thought it could happen to you. But it has. Cancer favours no-one and the news can be a devastating blow to you and your family. The earlier treatment can begin, the better. Here's what you need to know about oncology benefits at CMP.

Obtaining treatment

Different types of cancer require different types of treatment - from radiation to chemotherapy or even surgery. Before any course of treatment can begin, however, it's vital you contact us for the following reasons:

• According to the rules of the Scheme, we may only cover treatment appropriate to your chosen product option.
• All oncology treatment must be pre-authorised. You will need to send us an oncology treatment plan from your oncologist.
• Oncology benefits are paid out directly to members, not to the treating oncologist.

How we cover oncology

• All product options: We cover oncology treatment as a PMB, and according to the SA Oncology Consortium's Treatment Guidelines, at 100% of the NHRPL/CMP tariff.
• Healthpact Select: We cover evidence-based treatment for curative therapy, according to international standards, at 100% of the NHRPL/CMP tariff.
• Members across all CMP plans receive ongoing support, advice and treatment management from our Medical Case Management (MCM) division.
• For more information about oncology benefits, contact our MCM division at 0860 100 512 or email mcm@cmp.co.za.

Why we do what we do

Often, oncologists or doctors offer treatment plans to patients without due respect to their financial position or level of cover. Sometimes they even offer aggressive treatment to prolong a patient's life by mere weeks, despite no improvement to the prognosis or quality of life.

By obtaining pre-authorisation, we ensure that you receive the appropriate treatment for your condition and situation. We are also able to monitor and manage your condition, advise, and intervene where necessary. We do this on behalf of all our members and in the interest of ensuring the long-term viability of the Scheme.

Seasonal flu, or influenza, is a viral infection that can cause serious respiratory tract infections. It is different from swine flu, or H1N1, in that swine flu is a respiratory disease and has some elements of a virus found in pigs. With winter upon us and an influx of overseas visitors expected for the World Cup, it's time to protect yourself and your family.

Contamination

Both types of flu are spread from person to person and transmitted easily through infected droplets often expelled during coughing or sneezing. These droplets can contaminate hands and surfaces, and be inhaled.

Prevent contamination by always carrying tissues, using them to cover your mouth and nose when coughing and sneezing. Discard the tissues after use, taking care to wash your hands with soap and hot water regularly.

Symptoms

Once you're contaminated, it can take anywhere between one to five days for symptoms to appear. Symptoms include a runny nose, aches and pains, vomiting, diarrhoea, fever, fatigue, coughing and a sore throat. Anyone is at risk, especially people with compromised immune systems, pregnant women, young children and the elderly.

It's vital to protect yourself this winter

The Centre for Disease Control and Prevention recommends a yearly seasonal flu vaccine as the first and most important step in protecting yourself and your family against influenza. There are reported shortages of the 2010 vaccine but, if/when available, it does protect against the three seasonal viruses that research suggests will be the most common.

Other preventative options to explore include:

• Speaking to your doctor about anti-viral drugs that have been approved for the prevention of flu
• Speaking to your pharmacist about over-the-counter or natural immune system boosters
• Keeping your immune system naturally strong by eating healthily, getting enough sleep and exercise, upping your intake of vitamin C and/or taking a multi-vitamin

Getting better

If you catch a cold or the flu, make sure you:

• Get plenty of rest
• Drink lots of liquids
• Avoid alcohol and tobacco
• Consider taking over-the-counter medication (like nasal sprays and painkillers) to relieve the symptoms of flu
• Avoid direct contact with other people. If you are in the company of others, cover your nose and mouth when coughing or sneezing to protect them from your germs

As a continuation from last month's insert on specialist consultation fees, this month we bring you three more. These are the National Health Reference Price List (NHRPL) rates, also indicative of the maximum we will pay (the CMP tariff), for consultations:

These fees are for a normal/standard consultation as per ICD10 codes 0190, 0191 or 0192.

CMP Health Days

Our next two open days are scheduled for Tuesday 20 July and Thursday 22 July at our offices. Don't miss our free health checks between 09h00 and 16h00 (no need to book), an added benefit to members, which could otherwise cost in excess of R100 per person tested. There will be an industry related presentation at 12h00 on both days. Booking is essential - please RSVP to Charne Gordon at 021 937 8300 by 14 July to reserve your seat. Refreshments will be served.

HIV testing with CMP

Our government recently embarked on an intensive HIV testing and counselling (HCT) campaign, encouraging all citizens to get tested and to know their status. CMP advocates this stance, and has created specific protocols to allow members to be tested. To access the testing benefit, you will be required to fill out an application form (available from Customer Care), which will be subject to approval by our case managers.