Notice regarding Professional Fees 2017
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 the practice. We hereby inform our patients, insurance companies and colleagues that the billing policy of this practice does not necesarily follow the different rates at which the various medical insurance companies reimburse at, or that of colleagues or any price reference lists.
In 2010, the High Court made a ruling that there is no longer a legal standarised medical scheme tariff guideline, previously called the National Health Reference Price List (RPL). Since 2011 most of the medical schemes are now reimbursing at a percentage of their “scheme rate” – and both the percentage and value of “schemes rates” vary from one scheme to another e.g. 2010 RPL rates plus 5% or RPL rates plus 6%. Competition law requires each medical practice to disclose its billing policy which is determined according to the practice’s own costing structures and which is also in line with the provisions of the consumer Act.
The tariffs charged for healthcare services rendered in this practice are as follows:
- This practice charges consultation fees as paid by your medical aid. First consultations will have a co-payment of R300.00
- Fees will be charged according to a payment arrangement signed with certain medical schemes, all other medical aids will be charged at 1.5X scheme tariffs.
- All after hour and emergency work will be charged according to a payment arrangement signed with certain medical schemes or alternatively at aminimum of 2X scheme tariffs.
- Preferred provider rates may differ depending on the medical scheme the patient belongs to.
Patients can be given a formal quotation, on request, for procedures. It remains the patient’s responsibility to decide or ascertain with their medical aid what will/will not be covered. Each quotation will provide a patient with the applicable procedure codes and fees.
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. Even if the patient’s medical aid covers 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 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 aid will pay and any co-payments that might be applicable.
The medical practitioner and the practice reserve the right to charge any additional paperwork requested by your medical aid e.g. pre-authorisations, motivation 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 the 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 medical aid. Patients should discuss all fees related to the other healthcare professionals involved in the treatment plan (e.g. anaesthetist charges, physiotherapy, pathology laboratory tests, x-rays, scans) directly with 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 qiestions, please do not hesitate to ask the practice staff or doctor.
Kennisgewing insake Tariewe 2017
Hierdie praktyk heg waarde aan die verhouding met ons pasiente en wil daarom verseker dat daar totale deursigtigheid is met betrekking tot die moontlike kostes vir die lewering van mediese dienste. Hiermee gee die Praktyk kennis aan pasiente, kollegas, ander diensverskaffers, mediese fondse en verwante maatskappye dat die Tarief beleid van hierdie Praktyk nie noodwendig sal wees volgens die Rand waardes waarteen die verskillende mediese versekerings maatskappye dienste betaal nie, of volgens die tariewe van my kollegas of enige verwysings pryslys nie.
Gedurende 2010 het die HooggeregsHof ’n beslissing gemaak dat daar nie langer ’n wetlike gestandardiseerde mediese skema tarief lys, vroeër genoem die Nasionale Gesondheids Pryslys (NRPL) mag wees nie. In 2011 het meeste van die mediese skemas die besluit geneem om rekeninge te betaal teen hulle “skema tarief” and beide die persentasie en waarde van die “skema tarief” varieer tussen die verskillende mediese fondse, bv 2010 NRPL tarief plus 5% of 2010 NRPL tarief plus 6%.
Die Kompetisie Wet vereis dat elke mediese praktyk hulle tarief beleid moet bekend maak wat gebaseer is op die praktyk se eie koste struktuur en wat ook in lyn is met die bepalings van die Verbruikers Beskermings Wet (Consumer Protection Act).
Die standaard tariewe wat gehef word vir die lewering van dienste in hierdie praktyk is as volg:
- Die praktyk hef konsultasiefooie teen die tarief soos betaal deur u mediese fonds. Eerste konsultasies het ’n bybetaling van R300.00
- Fooie word gehef teen die ooreengekome tarief vir die fondse waar daar ’n spesifieke betalings ooreenkoms in plek is, alle ander fondse sal teen 1.5 X skema tariewe gehef word.
- Alle na-ure en nood werk sal teen 2 X skema tariewe gehef word.
- Voorkeur diensverskaffer tariewe, mag verskil afhangend van die mediese fonds waaraan die pasient behoort.
Die praktyk sal op versoek aan pasiente ’n geskrewe kwotasie voorsien vir prosedures. Die pasient moet dan met sy of haar fonds die tariewe bespreek en bepaal wat word nie ten volle deur die fonds betaal nie. Indien geen terugvoer ontvang word van die pasient nie word dit geag dat die kwotasie aanvaar word.
Daar is ‘n groot verskeidenheid van mediese fondse en plan opsies is (elkeen met sy eie ontwerp en hoeveelheid voordele). Dit bly die verantwoordelikheid van die pasient om te weet wat hul betrokke mediese fonds of versekeraar vereis en bepaal ten opsigte van tariewe, voorkeur verskaffers, verwysings vereistes, vooraf magtigings, formulariums, limiete ensovoorts. Selfs al word sekere operasies deur die fonds betaal beteken dit nie noodwendig dat al die prosedures kodes betaal word nie. Stel asseblief die praktyk in kennis indien daar enige spesifieke reëls is waaraan jy moet voldoen op jou spesifieke plan bv voorkeur diensverskaffers ens. Hierdie tipe van reëls kan ’n invloed hê op die fooie wat jy moet betaal, watter gedeelte die fonds gaan betaal en enige bybetalings wat ook gehef kan word. Die dokter behou die reg voor om kostes te eis vir enige motiverings of papierwerk wat die pasient se mediese fonds of verwante maatskappy verlang (bv. chroniese medikasie vorms, vooraf magtigings en motiverings).
Al sou die Praktyk die rekening (vir dienste gehef aan die pasient) stuur na die pasient se mediese fonds, sal die pasient verantwoordelik bly vir die volle vereffening van die rekening. In die geval van geen of onvolledige betaling deur die mediese fonds, sal die pasient ook verantwoordelik gehou word vir rente (soos per die Nasionale Krediet Wet) en enige invorderingskostes wat die Praktyk moes aangaan. Die pasient moet ook die tariewe direk bespreek met enige ander dokters of verwante diensverskaffers wat betrokke gaan wees by die pasient se hanteringsplan (bv. Narkotiseur, laboratorium ens).
Indien die mediese fonds nie aan jou as pasient duidelikheid kan of wil gee ten opsigte van jou versekerde voordele of die tariewe wat hulle sal betaal nie, rig ’n klagte teen die fonds by die Raad op Mediese Skemas by complaints@medicalschemes.com of telefoon nommer 012 431 0500.
Bespreek asseblief enige finansiële versoeke, vrae of onduidelikhede met die dokter of praktyk personeel.
FEES FOR COLONOSCOPIES DONE IN ROOMS
Due to the fact that all medical aids reimburse the provider differently for the same procedure the following co-payments apply for colonoscopies done in the rooms:
Bestmed patients: No co-payment by patient
Gems and Discovery patients: R500 co-payment by the patient
All other medical aids: R1 500 co-payment by the patient
Private patients: R4 500
Please take note that you, as the patient, is liable for this co-payment and is payable on the day of the procedure. (No pay-off arrangements applicable.)
Dr van Schalkwyk makes use of the services of an anesthetist to do the conscious sedation for the procedure. You/your fund will receive a separate invoices for the anesthetist’s services, please esquire about his co-payment with our practice. You can send an email or phone our practice. Please state the date of your appointment.