Terms and conditions
This practice values its patients and would like to ensure complete transparency regarding the patients’ possible medical costs when involved with the practice. We hereby 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 other colleagues or any price reference lists. The reasons are as follows:
The Department of Health (DoH) published the National Health Price List (NHRPL) in 2006 and this list was also adopted by HPCSA as the Ethical Tariff. The DoH later changed the NHRPL to reference price list (RPL). The publication of this list was followed by the publication of regulations relating to the obtainment of information and the processes of determination and publication of the NHRPL in 2007. In 2008, the HPCSA took a decision to scrap the Ethical Tariffs. In 2010, the DoH RPL was reviewed, declared invalid and set aside by the High Court of South Africa (North Gauteng Division, Pretoria) (www.hpcsa.co.za).
Therefore, there is no longer a set medical tariff in South Africa and every medical aid chooses its own level of reimbursement. Thus, each medical practice has to decide what their cost structure and billing policy is. 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.
Billing policy »
When making your booking, please enquire about the consultation fees of the practice, which will also be clarified on the day of the consultation. Fees may also change depending on the complexity of the problem and time spent with the patient.
It is the responsibility of the member to be aware of their benefits from THEIR scheme and to interact with THEIR scheme. However, please be advised that in some instances as a service to you, this practice may submit the account directly to your medical scheme. Even if the practice submits the account to a medical fund for re-imbursement, the patient ultimately remains liable for the full costs & service fees and 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 medical aid.
Being a member of a medical scheme is your choice and an arrangement between the MEMBER (yourself) and the SCHEME. The service provider (the practice and its doctor) is NOT part of that agreement.
Because of the varying and different benefits and exclusions on the different medical aid plan options in the market, it remains the patient’s responsibility to validate with their medical aid what procedure codes and reimbursement tariffs are applicable on their plan.
Fee structure »
- First consultation: This is to be settled by the patient at the practice upon first consultation (Please contact practice regarding the amount as this changes every year).
- If your condition happens to fall under the prescribed minimum benefit (PMB) list your medical aid should cover the costs. Please feel free to contact us regarding this.
- Follow-up consultation: Medical Aid tariffs, or Private tariff if patient is a private patient.
- Emergency consultation: This is to be settled by the patient upon first consultation (Please contact the practice regarding the amount as this changes every year).
- Professional fees: certain professional activities (prescribing of chemotherapy, etc.), command a daily or per script professional fee. Please inquiry at the reception or your medical aid the amount of this value.
- You will be charged medical aid rates which may carry a co-payment depending on the medical aid tariff and the level of your benefits.
- If we do not have a contract with your medical aid, your medical aid might not pay us in full for certain procedures. You are responsible to pay this amount. Blood Centre cannot be held responsible for any short payments or copayments applied by your medical aid.
- If we have a contract with your medical aid you will not be charged a cash fee for a consultation or follow-up unless your day-to-day benefits are depleted. It remains your responsibility to keep track of your limits in your day-to-day fund. Feel free to ask us for a list medical aids that we have a contract with.
- Private patients will be billed according to our practice rate, please enquire on a quotation. A quotation is merely an estimation of the costs.
- Kindly be aware that other service providers such as pharmacy and Cancercare are separate entities from our practices and will be billing separately as per their own tariffs.
The following tariffs are also payable and must be paid upon collection (not fax / e-mail) of these relevant items:
- Telephonic consultations (tariff code 0130)
- Repeat prescription will not be issued without a consultation with the doctor. Should a repeat prescription be issued without a consultation, this will be charged for (tariff code-0132)
- Fees are payable for every prescription. Repeat prescription will not be issued without a consultation with the doctor.
- In the unlikely event that a repeat prescription is issued without a consultation, this will be charged for (tariff code – 0132 “consultation service e.g. writing of repeat scripts or requesting routine preauthorization without the physical presence of the patient (needs not be face-to-face contact (“Consultation” via SMS or electronic media included).
- The writing of special letters and motivations with/without the patient (tariff code-0133)
- The completion of chronic medication forms (tariff code-0199)
- The provision of medical reports and results for insurance purposes / assessments.
General housekeeping guidelines »
It remains the patient’s responsibility:
- to read his/her medical aid rules. This is especially important regarding referral letters, medical scheme exclusions, authorisation numbers for specialist visits and procedures, short payments and co-payments for procedures.
- to acquire an authorisation number for specialist visits and hospital admissions. Please remember that according to the medical aids, an authorisation number is not a guarantee of payment, your medical aid might choose to honour all, part or none of your final account whereby you, as the patient, will be responsible.
- to attend to a consultation or phone the practice to enquire about your test results.
- to phone the practice to book a follow-up consultation after any procedures.
- to submit the invoice to medical aid scheme and to follow-up on its reimbursement. Non-timeous submission may result in rejection of the claim.
- the payment of services rendered by Blood Centre and should you not pay timeously, you will be liable for debt recovery costs.
- to enquire about your account should you not receive one. We make use of sms’s, emails, post and phone calls to inform you of outstanding accounts.
- pay all outstanding accounts in full within 30 days from date of service. We reserve the right to charge interest and a service fee on accounts older than 30 days.
- It often happens that the medical aid pays the patient (and not the practice) and then the patient has to pay Blood Centre for the services rendered. In such instance, the patient is responsible to pay his/her account to Blood Centre within 3 days of the money being deposited into their bank account.
- Reminders are sent out for appointments. Please be courteous to cancel / reschedule should you be unable to honour the appointment. Unless your empty time slot is filled, missed appointments and those not cancelled more than 24 hrs in advance will be charged for.
Certificates and other documents »
The medical practitioner and the practice reserve the right to charge for any additional paperwork requested by your medical aid, insurance company (or any other 3rd party) e.g. pre-authorisations, motivation letters, chronic medication forms or reports.
The onus & responsibility lies with the member to acquire the appropriate forms from their medical scheme.
- The completion of such forms is charged on Medical Aid tariff code: ‘0199 – Completion of chronic medication form with or without the presence of the patient’. PLEASE ASK FOR A QUOTE prior to sending the form to the practice.
- Forms are to be e-mailed to the practice to email@example.com
- Please indicate the patient for whom the form is to be completed.
- The forms will be completed by the doctor using the information from the patients’ file. In submitting the form to the practice, the patient automatically consents to their confidential details being revealed to a third party.
- Fees are payable for every form completed (even repeat motivations), irrespective of the approval by the medical scheme.
- It is the responsibility of the MEMBER to submit the forms to the medical scheme and to follow-up on its outcome. We offer the service to our patients but do not guarantee payment by the fund. If you opt to submit yourself, please keep in mind that non-timeous submission may result in rejection of the application.
- Should a special letter/ motivation be issued with OR without a consultation, this will be charged for (tariff code 0133 – “writing of special motivations for procedures and treatment without the physical presence of a patient (includes report on the clinical condition of a patient) requested by or on behalf of a third party funder or its agent”).
- Fees are payable for every completed document, irrespective of the success of the motivation.
- Should an insurer request that a PMA (Personal / Physician Medical Attendant) report be completed for an insured individual / patient, this will be charged for. Please ask for a quote since this varies depending on the type of report requested and the complexity of the report.
- Although most insurers agree to pay for the costs of such reports directly to the practice, the patient shall be ultimately liable for all fees regarding such reports.