This practice charges fair and reasonable fees

This Practice charges a standard tariff or the tariff as set out by the medical schemes with which we are contracted. The following factors could influence the tariff: membership to a medical scheme; the medical scheme; the contract with the medical scheme; the plan or option of the medical scheme.

This Practice has contracted with Discovery (Excluding Keycare options), Bonitas, Fedhealth, Momentum, Polmed, Bankmed, Medshield and GEMS to ensure that you do not have to make a co-payment. Where your medical scheme is unwilling or has not entered into an agreement with this Practice, you could be responsible for a co-payment or the total amount of the consultation. This would depend on whether your scheme can guarantee direct payment of the balance of the account. If you do not belong to a medical scheme, you will be responsible to settle your account at the time of every consultation.

Please note that some medical scheme plans or options do not provide for these services. Irrespective of medical scheme membership or involvement, you remain fully responsible for the full settlement of the account. You are responsible to ascertain the benefits and limits of your medical scheme and to obtain any authorisation from your medical scheme which might be necessary.

Please note the following important information

Members of the following medical aids require a specialist referral number from their general practitioner before a claim can be made with their scheme: GEMS, Bonitas, Discovery Keycare, Commed, Sasolmed, Medshield, Keyhealth and Medihelp. This number is generally valid for 6 months. Without such a number the member remains liable for the consultation fees, regardless of PMB registration.

Non-contracted medical schemes will be subject to a R200.00 co-payment for each follow-up consultation by the member, only if the rate the scheme pays for 0162/2974 code < R1200.00. (except for the schemes mentioned below). This payment is due regardless of whether PMB has been approved and is applicable to 0161, 0162, 2957, 2974, 7023 and 7026 codes.

Cash payments will never exceed the practice’s private rates. Should the total of a new consultation exceed the private rate, the 2974 code will be decreased to bring the total to the private rate.

Members of the following medical schemes, will be requested to pay the full private consultation fee in cash or by credit card and claim the the amount that their scheme will pay themselves: Affinity, Allied, Barloworld, Bomaid, Building Industrie, Cape Medical, Cigna, Commed, Compcare, Genesis, Grintek, HaloCare, Health Squared (previously Spectramed and Resolution Medical Aid), Hosmed, Makoti, Medipos, Namibië, Old Mutual, Opmed, Parmed, Pharmed, Platnium Health, Sedmed, SES, Sisonke Health, Thebemed, Umvuzu, Unihealth Africa and Wooltru.

Members of Bestmed will be requested to pay a R300.00 co-payment for each follow-up consultation and R700.00 for a first consultation.

The practice will not charge any co-payments for in-patient consultations, regardless of it’s contracts with medical schemes.

For a first consultation the practice charges two codes: 0162 + 2974 (Private rate: R1300.00 + R2100.00 = R3400.00). For a follow-up consultation the practice charges one of the following codes: 0162 (Private rate: R1300.00); 2957 (Private rate: R1060.00) or 2974 (Private rate: R2100.00). This depends on whether PMB was approved, whether the consult was in-person or via Telehealth and the duration of the consultation. The code will be determined during the consultation and if possible, PMB will be applied for. The default code remains 0162.

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To clarify the complicated and obscure process of medical scheme claims, we have designed a flow chart according which we process billing and fees. You can use this flowchart to see what costs you may be responsible for.

Billing Procedure

This practice charges fair and reasonable fees

Please note the following important information

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