01
Patient Records
Full surgical history and medical aid details, always current.
RECONSTRUCTIVE // NOT COSMETIC
The word "aesthetic" has cost your practice enough.
PlastFlow builds objective, data-driven motivations that reframe every case around documented pathology and function — so the algorithm that auto-rejects "cosmetic" procedures never gets the chance.
Motivation · DraftCASE-2026-0418
Dear Reviewer,
With reference to the above member, the patient is requesting breast reduction to improve her appearance.
Supporting evidence: Schinkel grade III · Estimated resection ≥ 500 g per side · 18 months conservative management.
SAMA 0315 · ICD-10 N62Declined
EXCLUSION 3.1 // THE PATTERN
Gigantomastia, septal deviation, scar contracture — declined on sight.
South African medical aids routinely flag plastic and reconstructive procedures as cosmetic by default, regardless of documented functional impairment. The decision is often algorithmic, made before a clinician ever reads the file.
The burden then falls on the surgeon's admin team to prove, case by case, that this isn't elective — using language the scheme's review process is built to recognise, not the language a surgeon naturally writes in clinical notes.
MODULES // 01–04
Built to make "cosmetic" indefensible.
02
Procedure Library
Reconstructive, oncoplastic, trauma, and congenital codes — mapped to the right ICD-10 every time.
03
Functional Evidence Matrix
Procedure-specific checklists that capture the exact objective data each case needs — resection weight, NOSE score, Vancouver Scar Scale, and more.
04
Authorization Lab & Appeals
Motivations that reframe automatically. Appeals that cite CMS Circular 40 of 2014 back at the scheme.
WORKFLOW // 5 STEPS
From patient to a case the scheme can't dismiss.
- 01PatientStep 1
- 02ProcedureStep 2
- 03Functional EvidenceStep 3
- 04Clinical NotesStep 4
- 05MotivationStep 5
REQUEST ACCESS
Make your next rejection the last one.
Tell us about your practice. We'll set up your workspace and train your team.