Notice regarding professional fees

This practice values our relationship with our patients and would like to ensure complete transparency on the patient’s possible medical healthcare costs associated with this practice.
We herby inform our patients, insurance companies & colleagues that the billing policy of this practice does not necessarily follow the different rates at which the various medical insurance companies reimburse at, or with that of colleagues or any price reference lists.

In mid-2010, the High Court made a ruling that there is no longer a legal standardised medical scheme tariff guideline, previously called the National Health Reference Price List (RPL). In 2011 most of the medical schemes are now reimbursing at a percentage of their “scheme rate” and both the percentage and value of the “scheme rate “vary from one scheme to another e.g. 2010 RPL rates plus 55 or 2010 RPL rates plus 6%.

Competition law requires each medical practice to disclose its billing practice which is determined according to the practice’s own costing structures and which is also in line with the provisions of the Consumer Protection Act. The tariff charged for healthcare services rendered in our practice is as follows:

 

Pregnancies:

Discovery classic options: R400 co-payment per consultation + claim from medical aid

Remedi comprehensive + classic plans: R400 co-payment per consultation + claim from medical aid

Delivery: No co-payment

Bestmed: No co-payment

 

All other medical aids:

1st Pregnacy visit: R1800

11-14 weeks (NT sonar): R1500

Follow-up visits (16 week): R1000

Anatomy scan (20-24 weeks): R1800

Follow-up visit (24-38 weeks): R1000

Follow-up visit (>38 weeks): R750

Co-payment for deliveries (payable between 34-38 weeks): R4500

Private fees: Same as the above

Private delivery fee: R10000 (payable between 34-38 weeks)

Procedures

this practice will provide a patient with a written quotation. It remains the patients responsibility to decide or ascertain with the medical aid, what will/will not be covered. Each quotation will provide a patient with the applicable procedure codes & fees. A day cooling-off period applies after the quotation has been accepted.

Because of the varying and different benefits and exclusions on the different medical aid plan options in the market, it remains the patients responsibility to validate with their medical what procedure codes en reimbursement tariffs are applicable on their plan. Even if the patients’ medical aid cover a certain procedure, it does not necessarily imply that the medical aid will reimburse all the procedure codes charged by the practice. Please inform the practice if there are any specific pre-conditions which you may have to adhere to on your medical scheme plan e.g. medicine formularies, preferred or designated service providers etc. These aspects can have an influence on the fees you might have to pay, what portion your medical will pay and any co-payments that may also be applied.

The medical practitioner and the practice reserve the right to charge for any additional paperwork requested by your medical aid e.g. Pre-authorisations, motivations letters, chronic medication forms or reports.

Even if the practice submits the account to a medical aid for re-imbursement, the patient ultimately remains liable for full costs, the interest as specified in the National Credit Act, and for any costs incurred in the recovery process in the event of the account not being settled in full by the treatment plan (e.g. anaesthetist charges, physiotherapy, pathology laboratory tests, x-rays, scans) directly to them.

Should your medical aid not be able to clarify at which rates you are insured at, submit your complaints to the Council for Medical Schemes at complaints@medicalschemes.com or contact them on, telephone 012 431 0500

Should any of the above be unclear, or should you have any further questions, please do not hesitate to ask the practice staff or doctor.

Consulting Hours

Monday 09:00 – 18:00

Tuesday 09:00 – 18:00

Wednesday 09:00 – 16:00

Thursday 09:00 – 16:00

Friday 09:00 – 14:00

Saturday/Sunday Please refer to emergency contact number 0123336000

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