Kommunikasie
State word maandeliks aan pasiënte gepos.
Tariewe
Hierdie praktyk vra privaat tariewe. Die gedeelte hiervan wat gedek word wissel van mediese fonds tot mediese fonds, en wissel ook tussen die verskillende opsies binne 'n mediese fonds. Kosteberaming word op versoek voorsien.
Elektroniese indien van eise
Alle eise word elektronies gestuur aan mediese fondse wat by die QEDI stelsel geregistreer is. Dit bly egter die pasiënt se verantwoordelikheid om te bepaal watter gedeelte deur die mediese fonds betaal word, en of betalings aan die diensverskaffer of die pasiënt gedoen word.
Laat betalings
Rekeninge wat meer as 90 dae uistaande is word aan ons skuld-invorderaars oorhandig, en die pasiënt word verantwoordelik gehou vir enige addisionele kostes daarvoor aangegaan.
Die rekeninge afdeling kan gekontak word tussen 8 en 12 voormiddag by die volgende nommers:
Tel: (021) 939 7416
Faks: (021) 930 1240
E-pos: dmsanaes@iafrica.com
Mediese rekeninge aan die verander
Vanaf 2004 is daar geen aanbevole of vasgestelde tarief vir mediese dienste nie. Volgens die landswette mag daar ook nie mediese fonds tariewe, "ingekontrakteerde" tariewe, "uitgekontrakteerde" tariewe, of SA Mediese Vereniging tariewe vasgestel word nie.
Dit beteken dat dokters toegelaat word om enige tarief wat geregverdig kan word, te vra. Aan die ander kant kan mediese fondse weer besluit watter voordele hulle bereid is om te betaal.
Dit beteken verder dat pasiënte verantwoordelik is vir die vereffening van hulle rekeninge, en bereid moet wees om die gedeelte te betaal wat nie deur die mediese fonds gedek word nie.
Tariewe en persepsies verander voortdurend en hierdie is 'n poging om u ingelig te hou.
Wat egter onveranderd bly is ons toewyding om gehalte mediese sorg aan u te lewer.
U is welkom om enige onsekerheid of bekommernis met ons te bespreek.
Koerantartikel in die 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
