In the current medical aid market environment, patients are purchasing lower cost medical aid plans with restrictive limits on treatment with less benefits, medicine restrictions, limited hospitalization and surgery cover, public hospitals as providers of pre-determined treatment and surgical procedures, and restrictions on access to doctors.
Your treatment, financial costs, and quality of your professional care can be severely affected by the type of medical plan you belong to and the generalization of statements such as "100% cover" by your medical aid may or may not correspond with all the aspects of treatment you may require. These limitations often prove problematic for your doctor as the right to obtain the necessary professional medical care that meets an acceptable standard is being influenced by your choice of medical aid cover.
This practice charges private rates which may be higher than the rates covered by your medical aid plan. You are personally liable for the full amount charged at each visit. It remains your primary responsibility to familiarize yourself with the benefits and conditions of your medical aid plan. It is important that you know your benefit status with regard to the extent of your health cover, referral restrictions, savings account balances registration and preauthorization processes, waiting periods and other requirements. The Medical Schemes Act 131 of 1998 and its regulations entitle members of a medical scheme to all information on their benefits and limitations of their plan. You are responsible to acquaint yourself with the benefits, insured rates and terms and conditions of your medical scheme plan.
Ascertain the exact amounts your scheme provides for in terms of consultations, procedures, assistants as well as what your medical aid will pay and not pay for. Where a Designated Service Provider has been appointed by your medical aid, it remains your responsibility to be cognizant of this and to bear responsibility for any restrictions that may follow (either medically or financially) when consulting a non- designated doctor or facility. With ever increasing intervention from your medical scheme, please be aware that this practice will not allow a medical scheme to violate the doctor's professional and clinical independence.
Where a medical aid or its advisors intervene to overrule your doctors preferred diagnostic approach or treatment, your doctor assumes no responsibility for consequent adverse outcomes. You may be asked to assume responsibility to the medical aid and its medical advisors in the event of complications.