Doctor wins bid forcing Gems to cover cancer treatment

A medical doctor's fight to get the Government Employees Medical Scheme (Gems) to pay for his cancer treatment has ended in victory after the company buckled under pressure and agreed to cover it.

Gems reviewed Dr Sipho Bvuma's application for it to pay for an expensive drug called Keytruda to treat his stage four cancer.

Sowetan previously reported that a frustrated Bvuma, 47, who works at the Chris Hani Baragwanath Academic Hospital, took the scheme to court after it refused to pay on the basis that the drug was not registered to treat his condition.

"The applicant's condition, unfortunately has reached an advanced stage and the cost of the treatment is not justified under the circumstances.

"At the end of the day, Gems cannot pay for treatment that will not achieve the desired result of saving the patient's life," it stated.

However, yesterday Bvuma's family and Gems confirmed that the company had approved the request after it was reviewed by an independent panel of oncologists.

Bvuma's case, though different, mirrored that of Momentum insurance which capitulated to public pressure and changed its stance to refuse paying out R2.4m death claim by the family of Durban man Nathan Ganas. He was shot and killed in a hijacking.

Ganas's claim was declined by the insurer on the grounds that he had not disclosed that he was diagnosed with raised blood sugar levels, which may have occurred before he completed his application for the policy in 2014.

In Bvuma's case, Gems chief operations officer Dr Stan Moloabi said they had informed him of the decision to grant his request following an urgent ex gratia process.

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• mahopoz@sowetan.co.za