Raymond Pleaner – Fighting the good fight

Raymond Pleaner shares the dispute he had with his medical scheme to get immunotherapy treatment approved. Thankfully, the end result was in his favour. 

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Raymond Pleaner (70) lives in Sandton, Gauteng with his wife, Marcelle. They have three children and nine grandchildren. 

In June 2024, Raymond was diagnosed with cancer which was on the cusp of his oesophagus and stomach. He had no symptoms, but it was thanks to the keen eye of his pulmonologist (Raymond has lung issues due to COVID) who noticed something was amiss. 

“He noticed I didn’t have the energy I normally have and asked how I’m feeling; I was tired. He sent me for an iron test and I have to thank him for thinking out the box. My iron was extremely low, and he booked me in to have a gastroscopy and an endoscopy. This is when the tumour was discovered,” Raymond explains. 

More scans were done before a consultation with an oncologist.

Due to the location of the cancer, a gastrectomy (removal of the entire stomach) was proposed. His intestines would be attached to the remaining part of the oesophagus. However, chemotherapy would be needed first and thereafter. 

Declined treatment

The oncologist proposed chemotherapy and a new immunotherapy (pembrolizumab). “Since this was a newer treatment regimen, my medical aid took over a month and half to make a decision. 

It was sent for review; we got told that the society who reviews it has agreed and 50% of the immunotherapy will be covered and the shortfall will be on us. 

A week later, it was back under review and then we were told that the medical scheme had declined the three cycles of immunotherapy,” Raymond explains. “This made the whole process even more stressful; my medical scheme was making decisions about my life.”

Fortunately, Raymond could afford the three cycles of pembrolizumab (which are R82 000 each) and he began treatment in August 2024, along with chemotherapy which the medical aid approved. 

Even though Raymond experienced side effects (fatigue, change in taste, neuropathy), he made a point of getting up every day. Though he notes how his social life dwindled completely. 

“We are social people, going out a few nights a week but I was too fatigued. My wife had to go out by herself on many occasions, and we are so used to doing everything together.”

Since Raymond was retired, they also had plans of travel but all that was put on hold. 

Gastrectomy

Before having surgery, it was noted that there was a significant reduction in the tumour. In November 2024, Raymond underwent a gastrectomy; 17 lymph nodes were also removed as well as a small section of the oesophagus. 

“Everything was sent for histology and only one node had a smidge of cancer in. The surgeon said this was unprecedented and would have never happened if I didn’t have pembrolizumab,” Raymond says.

Due to his stomach been removed, Raymond doesn’t produce stomach acid which effects the absorption of the food he eats. After surgery, he had a feeding tube and could only suck ice. Then he slowly moved to clear liquids then soft foods. Since he can only eat small amounts at a time now, he eats six times a day. He also has to have a vitamin B12 injection monthly and avoids fatty foods as well as popcorn and seeds. Another side effect is he now has bile reflux which makes him nauseous. Unfortunately, there is no medication for this. He still consults with a dietitian. 

In total, Raymond has lost roughly 17kg since starting treatment and is very self-conscious of his weight, even asking his wife to take the mirrors out the bathroom. 

Discussion with medical scheme

Once Raymond recovered from surgery, he had a further two cycles of pembrolizumab in January 2025. The oncologist applied to the medical aid and it was approved and then declined a few days later.

This confusion and added stress were the final straw and Raymond along with his financial broker demanded a meeting with his medical scheme. He goes on to say, “What happens to the person who can’t afford paying for it, are they left to die? Why are medical aids playing God?”

In the meeting, it was explained that Raymond couldn’t have any more chemotherapy and needed to continue with pembrolizumab as it was effective. 

The meeting resulted in the medical scheme paying for one of the cycles Raymond had in January as an apology for the computer glitch that said his treatment was approved, and they agreed to cover 75% of a further six cycles. Raymond is currently undergoing these treatments.

“I’m not only advocating for myself but also for those who can’t afford it. Before we walked out, one of the representatives asked if she could hug me.”

Looking forward with gratitude

Raymond and his wife are grateful for all the support they received from their children, friends, and family and are looking forward to picking up their social life. “I’ve got a whole new digestive system and I need to give it a chance to recover,” Raymond says. Though, he is happy that he can now eat a small chop when he goes out for dinner.