I had to have a mammogram and sonar for a lump discovered under my arm and my treating doctor was concerned as the lump is about 3cm in diameter. I called Essential Med / Carecross for authorisation and gave the ICD 10 codes over. I was supposed to be given authorisation by 9:30 yesterday morning when I went to Drs De Beer De Jager at Unitas Lifestyle which contracts to Carecross. They did not come back to me and I went ahead with the Mammogram and sonar. Eventually just after 4 PM yesterday they called me. The mammogram was declined and they say they will only cover me if something seriously wrong was found. I stick within their network doctors, I always supply the right codes and i pay just over R600 a month and I cant even get cover for a mammogram that is essential when a lump is discovered, benign or not. If they had called me on time I would have cancelled the mammogram and found a clininc that does them for free. But no, they didnt call me in time and as it was an emergency and having faith in them that they would approve this procedure, I went ahead and I am now indebted to the doctors for over R3000.00. I am extremely disgusted! Essential Med my foot! Essential!!
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