Source: Council for Medical Schemes
All the clinical and private information necessary to participate in disease management programmes has to be treated as confidential by the operators (medical scheme or managed care organisation) of the programme.
HIV is a PMB. No, this is not a rap song's lyrics; however, these acronyms are sure to put a bounce in your step when you see what they can do for your health and your pocket.
HIV/Aids is a disease that strikes fear in people's hearts. The one important message to get across, however, is that a positive test result is not a death sentence. Medical schemes are increasingly geared towards giving people living with HIV/Aids that much‐needed extra bit of support for a healthy and productive life.
Most medical schemes in South Africa make specific provision for the treatment of HIV – provided that members declare their status. As with any other medical condition, your scheme can only make the benefits available to you if they know that you are suffering from the particular disease.
By disclosing your HIV status to your medical scheme, you might qualify for more benefits than when you seek treatment for the individual symptoms or opportunistic infections associated with HIV/Aids.
However, the stigma associated with HIV/Aids in our society makes it very difficult for people to disclose their status and seek help. According to the Council for Medical Schemes, scheme members' privacy is protected by the Medical Schemes Act. The scheme and its contracted parties, such as doctors and pharmacies, may not share any information about a beneficiary with anybody else, be they employers, spouses or even the main member. All clinical information, including a person's HIV status, has to be treated as confidential.
But what about the medical scheme statements that are sent to the main member – don't they reveal what a person was treated for? Definitely not, says the Council spokesperson. The statement only lists the service provider(s) involved, such as the GP, specialist or pharmacy, and in some cases the medication prescribed. Unless someone goes to great lengths to find out what a particular drug is for, the patient's illness remains between her and the service provider.