Cancer treatment on AMS and what you need to know for funding

One cannot prepare oneself for a cancer diagnosis, but AMS will try and assist its members with understanding the basics of treatment and the practicalities of funding. Once diagnosed, the doctor will compile a treatment plan for the patient. There are many types of possible treatments. Which treatment is the best for which patient depends on the type and stage of the cancer and the patient’s overall condition and health. Treatment could include surgery, chemotherapy, radiation, immunotherapy, targeted therapy and/or hormone therapy.

For AMS to make the oncology (cancer treatment) benefits available, the doctor needs to register the condition with the Scheme by submitting all relevant clinical information, such as test results and the suggested treatment plan. In most cases this happens automatically, and the patient would receive a call from their dedicated AMS oncology case manager to take them through the process. The patient would also get their oncology case manager’s contact details for any query they might have later.

The Scheme’s oncology team will assess all the information received from the doctor and will advise on what the Scheme will fund. Reimbursement will be done as per the Scheme Rules. The patient would need to ensure that any additional components, not included in the original treatment plan, will be reviewed by the Scheme again for authorisation. Registration on the programme does not mean that everything is always covered. There could be certain medication that one might take that is not necessarily part of the oncology management. In other cases, a doctor might prescribe more scans than were included in the initial treatment plan, so the patient would always have to consult with the oncology case manager to confirm if and how these are covered.

The cancer treatment might aim to kill or shrink the cancer cells, which could result in healthy cells being destroyed as well. During this process, the patient might also require palliative treatment to reduce symptoms or side effects and to generally improve the quality of life. Palliative treatment can be available from the start of the treatment up to the end of life, when cancer might not be curable any more. The Scheme also offers a benefit called the ‘Advanced Illness Benefit’ where end-of-life management is funded as per the approved treatment plan.

Testimonial from a long-standing member:
“I have been, and remain, a member of your oncology programme for the past six years. There is not a day that goes by that I do not thank God and AMS for my miraculous survival.” Roy Anderson, age 79.

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