Billing

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Elective procedures and consultations

We do not claim from your medical aid for elective procedures, x-rays or consultations

For in-hospital elective (planned) procedures, this practice will provide a patient with a written quotation. Each quotation will provide a patient with the applicable procedure codes & fees.

Because medical aids and their plan options vary and have different benefits, exclusions and rules, it remains the patient’s responsibility to ascertain with their medical aid what will be reimbursed on the procedure codes and to obtain an authorisation.

Take note that an authorization or 100% cover does not mean that the medical aid will reimburse you in full. Your medical aid will only pay a 100% of the rate that are willing to pay for the procedure. This is not necessarily a 100% payment of the private practice rate.

In the case where a patient does not show up for an appointment or cancels an appointment within 24 hours prior to the appointment time, a consultation fee will be charged that is payable by the patient immediately.

Non-elective (Emergency) procedures

We claim all emergency (non-elective) in-hospital consultations and procedures directly from your medical aid.

In-hospital consultations and procedures are charged at private practice rates. If your medical aid does not pay within 30 days, it will be your responsibility to pay the full amount outstanding. Accounts that are not paid will be handed over. An admin fee and 2% interest will be applicable.

Note that this practice might charge procedure codes that will not necessarily get paid by your medical aid. The patient is responsible for any short payments.

It is the patient’s responsibility to make sure what tariff their medical aid will pay and of their medical aid rules regarding Designated Services Providers (DSP) and Prescribed Minimum Benefits (PMB).

Medical Aids pay (PMB) cases at fund tariffs which does not necessarily cover the practice tariff.

Should a patient make use of GAP cover, the patient must first pay the full account to the practice and then personally claim from their medical aid.

Breach of contract and Personal Information

In the event where the undersigned commits a breach of contract, the practice is entitled to take legal action.

The undersigned hereby authorises the practice to collect, share and exchange credit information concerning them with any credit bureau or any other person or corporation with whom they may have had or have financial dealings, as well as, where applicable, any other information requested to, or in any circumstances contemplated in the National Credit Act, Act 34 of 2005.

Furthermore, the practice is given the right to disclose personal medical information such as ICD10 diagnostic codes and clinical information pertaining to the patient to its legal representatives or debt collectors provided that such information is treated as confidential and in good faith and only insofar as it is necessary for debt collecting purposes.

Should the account not be paid timeously and legal action be necessary to recover any amounts in arrears, the undersigned shall be liable for the payment of all legal costs including attorney fees on an attorney-own-client scale, collection fees and commission, interest and tracing costs.

The parties choose the address on this document as the domicilium citandi et executandi.

This practice values our relationship with patients and would like to ensure complete transparency on the patient’s possible medical healthcare costs associated with this practice.

We hereby inform our patients, insurance companies, medical aids & colleagues that the billing policy of this practice does not follow the different rates at which the various medical insurance companies reimburse at, or with that of colleagues or any price reference lists.There is no universal “Medical Aid Rate” or “Reference Price List” fee that practitioners are required to charge.

All Medical Schemes have different conditions, limits, benefit levels and exclusions for treatment. We strongly advise patients to understand their Medical Scheme coverage. Your medical aid cover is a contract between the client (You) and your Medical Scheme and NOT between doctor and the Medical Scheme. Please consult your own Medical Scheme to determine their reimbursement policies for surgical services. We DO NOT accept any responsibility for your Medical Scheme coverage and you remain responsible for payment of all accounts.

Our treatment is based on your health needs and not according to your medical aid cover.

It is important that you understand and consent to both the treatment plan and the estimated cost of your treatment. Patients are encouraged to submit cost estimates to their schemes BEFORE proceeding with any treatment so that they may budget accordingly. You are requested to sign acceptance of our treatment plan and cost estimate. If clinical conditions require a change in treatment, details and cost will be provided whenever possible before proceeding with the modified treatment

It is your right to accept or decline our recommended treatment plan. If you reject or delay the recommended treatment, you do so at your own risk.

Acceptance

The undersigned, hereby acknowledge that he/she fully understand the above mentioned and accepts liability as the principal debtor, alternatively as co-debtor jointly and severally with the patient, for payment of any claims by the practice for services rendered.

I Agree / Ek Stem