Gavin Lee – My health, my right

Gavin Lee recounts the uphill battle of getting his medical scheme to fund his radical cystoprostatectomy.

Gavin Lee (65) lives in Weltevreden Park, Gauteng with his wife. They have two sons and one grandson.

In July 2025, Gavin noticed traces of blood in his urine; this prompted him to see his GP. A prostate-specific antigen (PSA) test was done and proved to be elevated and Gavin was referred to an oncologist. Here further imaging was done, and an MRI detected a tumour in his prostate as well as in his bladder. Biopsies were done on both which confirmed two primary cancers: Stage 2 muscle-invasive bladder cancer and Stage 2 prostate cancer. 

Gavin admits the news came as a shock to him and he found it quite stressful and difficult to inform his family.

It was advised that he undergo a radical cystoprostatectomy that would remove the prostate and bladder and in turn treat both cancers. However, Gavin would live with an urostomy (an abdominal opening to urinate) for the rest of his life. Gavin accepted this immediately. “I accepted the fact that the radical cystoprostatectomy would save my life and the urostomy would become a way of life,” Gavin says.

Since then Gavin has maintained a positive outlook. 

At first, living with a urostomy bag took a while to get used to, especially the leaks, having to learn to sleep predominately on his back, the overnight overflow bag, as well as learning tricks on how to shower with it. But he adds, these were overcome early on. Thankfully, he hasn’t had any side effects from the surgery.

Hospital plan hurdle

For 20 years, Gavin has been a member of a medical scheme making use of their hospital plan option. When he was diagnosed, he knew there would be co-payments as that is the norm with a hospital plan.

However, he never knew that finding a specialist urologist who could perform a radical cystoprostatectomy and was contracted to the medical scheme would be such an uphill battle.

Gavin explains, “The medical scheme provided a list of doctors who were contracted in. However, all of them only performed prostatectomies (prostate removal) and not a radical cystoprostatectomy, which I needed. 

The urologist who diagnosed me referred me to a specialist laparoscopic and robotic surgeon who was proficient in the surgery I needed but she wasn’t contracted to the medical scheme. This resulted in me having to pay 80% of the total bill which exceeded R100 000; payment had to be made upfront. Only 20% of the total bill was paid by the medical scheme which I thought was grossly unfair. I’ve been a member for over 20 years.”

Gavin then challenged the medical scheme, stating the doctor he used was done involuntarily as they couldn’t provide a specialist to do the procedure. 

He expressed his utter disappointment and that he would be left with no alternative but to take the matter further, if the decision wasn’t reconsidered.

Celebrating the win 

“Within two days of sending the letter, I received a reply stating that after consideration, the medical scheme would pay the doctor out of Prescribed Minimum Benefits (PMB),” Gavin says.

This was a huge relief for Gavin though he adds, “I had a positive outcome as I had the courage to challenge the medical scheme. But what about all those people who just accept what medical schemes decide and end up paying unnecessarily.” 

The medical scheme also covers the cost of all urostomy bags.

Gavin concludes, “My advice is: first of all, listen to your body. If something is not right, the warning signs are there, don’t ignore them. Secondly, don’t be fearful to take big medical schemes on.”

Valuable support

Gavin would like to thank his wife, Gayle, for her amazing support and acceptance of his diagnosis. She assists with changing the urostomy bag up to three times a week, without hesitation.

“The support and encouragement I got from my sons, Devon and Gareth, gave me the positivity I needed. I would also like to thank my sister, Debbie, who flew in from Kenya to give me the support I needed. To all the friends who sent me well wishes and visited me in hospital, a huge thank you,” Gavin says.

Laurelle Williams is the editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours Degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Write to [email protected]