Communication
Statements are mailed to patients every month.
Charges
This practice charges a private rate. The cost covered by medical aids vary from scheme to scheme, and within a scheme between the different options. The "gap" payment will depend on these. Estimates are available on request.
Electronic Submission
All claims will be submitted electronically to medical aids registered at the QEDI system. It remains the patient's responsibility to determine the amount payable by their medical aid, and whether payment will be made to the service provider or directly to the member.
Late payments
Amounts outstanding for more than 90 days will be handed over to our debt collectors for collection, and the patient will be responsible for additional costs incurred.
The accounts department can be contacted between 8 a.m. and 12 a.m. on the following numbers:
Tel: (021) 939 7416
Fax: (021) 930 1240
Email: dmsanaes@iafrica.com
MEDICAL ACCOUNTS ARE CHANGING
From 2004 there is no recommended or fixed tariff for medical services. To comply with the law of the country, there is no medical aid rate or "contracted in" fee, neither is there a " contracted out" or SA Medical Association rate.
This means that doctors are allowed to charge whatever professional fee they can justify. On the other hand, every medical scheme will determine the level of benefits they are prepared to pay.
This means that patients are responsible for paying their own accounts or at least expect an extra payment over and above the amount that the medical aid may agree to pay.
Rates and perceptions are changing rapidly and this is an attempt to keep you informed.
What has not changed is our commitment to render a quality health care service.
Please discuss your concerns with us.
Newspaper Article from Cape Times - "Medical aid fee facts"
Consumer watch (February 5) highlighted the problem concerning anaesthesiologists’ fees and medical aid schemes. I wish to add some facts to that very balanced article.
The problem of pricing is not restricted to anaesthesiology alone and is a global problem for all medical practitioners. All of the medical societies were approached by the Council for Medical Schemes (CMS) to do independent practice cost studies in order to determine an equitable rate of remuneration for 2007. This was done at great expense and the results were submitted to the CMS. The findings of these studies were simply ignored by the medical aids and regulating bodies when determining the 2007 reimbursements.
The department of Health then “illegally” released a fee for the National Recommended Price Listing (NRPL) for 2007 as being the 2006 rate plus an inflation rate of 4.9%. When legally challenged by the Medical Association of South Africa, this action was withdrawn. The result of this action is that no fee was set for 2007. The practitioners then applied the fee attained by the practice cost studies as their fee for 2007. This fee is certainly higher than that of 2006 but in the majority of cases is less than the “Ethical fee” set by the Health Professionals Council of South Africa (HPCSA).
The fact remains that the individual medical funders have now set their own rates for 2007 and these differ from funder to funder. In many cases these rates are less than the NRPL, this despite the fact that the monthly tariffs paid by the public have increased for 2007 at a level above the Consumer Price Index.
Put in very simple terms, the consumer’s medical aid contributions have increased in 2007 but many medical aids are paying out less than they did in 2006. The patient is getting less benefit for his increased monthly contribution.
The end result of this situation is that the majority of patients will find that they will have to make a co-payment to their medical practitioners to make up this shortfall.
It must be remembered that the medical aid societies have no right to decide what a doctor may charge for his professional services. They may decide what they will reimburse to their policy holder.
Consumer Watch makes some very sound recommendations to patients.
“Contact your medical aid to determine exactly what percentage of the NRPL, on your medical aid option, they will pay to the various practitioner to find out what the fee will be for the specific procedure.”
Dr Milton Raff
Vice President, South African Society of Anaesthesiologists Cramerview
