Local medical aid companies say they do indeed cover breast reductions linked to medical conditions. However, they say it is often difficult to prove a direct link between such operations and related medical conditions. This comes after local medical aid companies were challenged on social media for allegedly excluding breast reductions linked to medical conditions.
Juliet Harding, lead singer of GoodLuck and Momentum client, took to social media on 29 January to speak out against medical aid policies relating to breast reduction. Harding received a breast reduction on 28 January due to severe back pain. According to Harding, she had to cover all medical expenses.
Harding’s posts on the matter sparked the so-called Boobgate movement, where women from across South Africa spoke out about their own frustration and desperation regarding the subject. They have, among others, expressed their discontentment regarding medical costs incurred when visiting physiotherapists or chiropractors for conditions that were believed to be linked to breast size.
In her posts, Harding challenged Momentum and Discovery to review their policies on breast reductions, as well as the exclusion thereof. “All I would love to achieve is an open dialogue on behalf of the women in South Africa,” said Harding.
Following queries by MatieMedia, Momentum said in an official statement on 21 February, that the medical scheme “does consider and provides benefits for various breast surgeries related to illness and congenital abnormality, where clinical efficacy and cost effectiveness has been confirmed”.
“In cases relating to breast reductions to alleviate back pain, proving a substantive link between breast size, back pain and ultimately spinal surgery is more difficult than in most other procedures we cover,” according to the statement.
Momentum also indicated that it is currently in contact with Harding to discuss her case in more detail. Harding confirmed this.
Discovery indicated that it, too, does fund breast reduction surgery for members on higher plans who have specific clinical needs. “This funding has been in place for many years. Discovery does not pay for this surgery where it is solely for aesthetic purposes,” said Noluthando Nematswerani, head of the Clinical Policy Unit for Discovery Health.
According to Momentum’s statement, the group reviewed its clinical policies on an ongoing basis. “[W]e will continue to investigate and engage with experts in their fields to make sure our clinical policies support cost effective evidence based treatment, in the best interest of the entire membership base, and in a way that does not create an imbalance, or make medical scheme cover unaffordable,” it stated.
Juliet Harding, the lead singer of GoodLuck performing at Kirstenbosch Gardens. PHOTO: Instagram