If this is a medical emergency, call 10177 (ambulance) or go to your nearest emergency room immediately.
CANSA Patient Support: 0800 22 6622 (toll-free)
This article covers your medical aid rights during a melanoma-related emergency or coverage crisis. Read it once the immediate medical situation is stable.
What Your Medical Aid Must Cover in an Emergency
Melanoma is a PMB condition. In an emergency related to melanoma or its treatment, your scheme must fund emergency care at any registered hospital, regardless of network status, prior authorisation status, or whether your oncology sub-limit has been reached.
Common melanoma emergencies and PMB obligations:
| Emergency | PMB Status | Notes |
|---|---|---|
| Bleeding skin or lymph node mass | Yes — emergency PMB | ER stabilisation and procedure funded |
| Febrile neutropenia (post-immunotherapy) | Yes — PMB | Urgent hospitalisation required |
| Immunotherapy toxicity (severe colitis, pneumonitis, myocarditis) | Yes — PMB | These require urgent specialist admission |
| Brain metastasis: neurological deterioration | Yes — emergency PMB | Stereotactic radiosurgery or neurosurgical intervention funded where PMB |
| Spinal cord compression (vertebral mets) | Yes — urgent PMB | Urgent radiation or surgical decompression |
| Hypercalcaemia of malignancy | Yes — PMB | IV fluids and bisphosphonates in hospital |
| Pulmonary embolism (cancer-associated) | Yes — PMB (separate DVT/PE DTP) |
Important note on immunotherapy toxicities: Pembrolizumab, nivolumab, and ipilimumab can cause serious immune-related adverse events (irAEs) including life-threatening colitis, pneumonitis, hepatitis, and myocarditis. These are treatment-related emergencies that your scheme must fund as PMB complications of PMB-authorised treatment.
Hospital Admission: What to Know
Emergencies: Go to the nearest appropriate facility. Your scheme must fund emergency stabilisation regardless of network. Notify your scheme's emergency line (on back of your membership card) within 24–48 hours of admission.
Planned admissions (immunotherapy infusions, surgery): Pre-authorisation is required each cycle. Your oncologist's rooms typically manage this. Always confirm that the authorisation number is in place before presenting for treatment.
Immunotherapy infusion authorisation: Ask your case manager to issue a standing authorisation covering the full treatment course (e.g., pembrolizumab every 6 weeks for 12 months), rather than requiring individual authorisations per cycle. This reduces the risk of an infusion being delayed because an authorisation lapsed.
If Your Scheme Declines or You Cannot Pay
If your scheme declines a PMB service:
- Request written reasons for the decline.
- If it is a PMB service (surgery, staging, standard treatment, emergency admission), appeal in writing with supporting oncologist letter confirming PMB classification.
- Escalate to Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za.
If your oncology sub-limit has run out:
The sub-limit governs non-PMB oncology. If your exceptional-needs-approved immunotherapy or targeted therapy is the agreed treatment plan, the scheme has an obligation to honour ongoing authorised treatment within the benefit year. Contact your case manager to clarify the position on continued funding and — if necessary — escalate to the CMS.
If you have outstanding accounts you cannot pay:
- Request itemised accounts from all service providers.
- Shortfalls between scheme tariff and specialist charges are a separate matter from the scheme's obligation. Contact the practice manager for each specialist to negotiate a payment plan on the shortfall component.
- CANSA (0800 22 6622) provides patient advocacy support.
After the Crisis: Next Steps
- Confirm ongoing PMB registration is active with your case manager.
- Check your oncology sub-limit balance — know what has been paid and what remains for the year.
- Immunotherapy restart: After a treatment-related adverse event, immunotherapy may be permanently discontinued or restarted at a lower dose. Confirm authorisation for any resumed treatment protocol.
- New benefit year planning: Sub-limits reset on 1 January. Plan transitions of long-term systemic treatment across benefit years with your case manager in advance.
Resources and Helplines
Emergency services: 10177 (ambulance) | 10111 (police) CANSA: 0800 22 6622 (toll-free, weekdays) Melanoma SA: melanomasa.co.za Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za Talk to Eldon →