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Thread: DOCTORS FEES NOT PAID IN FULL BY MEDICAL AID

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    DOCTORS FEES NOT PAID IN FULL BY MEDICAL AID

    Hi , I have recently been approached by a doctor`s rooms demanding I pay the difference between what the Medical Aid pay and what was charged by him ,The procedure was done in April and an
    account was submitted to the medical aid by the practice ,which only paid a certain amount as per their rates .When at first accepting to do the procedure no discussions regarding costs was done and only the procedure was discussed . Authorisation was obtained for the procedure from the medical aid and at no stage was costs again discussed .The practice was then requested to supply a quote but this was not done .It was only after procedure done and medical aid paid there portion that an account for the outstanding amount ,about R30 000-00 was rendered .An acknowledgement that the practice does not charge medical aid rates and patient is liable was signed in 2008 .My question now is whether this demand is in contravention of both the Consumer protection act as well as the National Health Act and what recourse there is . Surely the service provider is aware that there is a discrepancy between what medical aids pay and what they charge and both acts place
    an obligation on the service provider to discuss costs in order to enable a consumer /patient make informed decisions .I have googled the different tariffs but found nothing conclusive .The original
    acknowledgement signed in 2008 can surely also not be held valid since the inception of the CPA and it being prejudicial ?

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    Site Caretaker Dave A's Avatar
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    Quote Originally Posted by JOHAN COETZER View Post
    Authorisation was obtained for the procedure from the medical aid and at no stage was costs again discussed .The practice was then requested to supply a quote but this was not done .
    Was this an urgent procedure?
    The trouble with opportunity is it normally comes dressed up as work.

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    No not an emergency although in severe discomfort

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    Platinum Member sterne.law@gmail.com's Avatar
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    Does the procedure fall under a prescribed minimum benefit (PMB), which would mean a full payment must be made.

    There are a number of questions - the private health profession is a closely guarded illuminati, very little statistical information is available.
    Informed consent in terms of the medical procedure is different to that of the cost factor.
    The failure to submit a quote will be useful, but your fight is against the doctor and not the medical aid.
    Your policy takes care of the fact that they only pay XYC (essentially about 1/3 given what specialist charge)
    Anthony Sterne

    www.acumenholdings.co.za
    DISCLAIMER The above is merely a comment in discussion form and an open public arena. It does not constitute a legal opinion or professional advice in any manner or form.

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