This practice charges private rates recommended by the ENT Society of South Africa and not the rates the Department of Health has unilaterally determined, which are known as the National Health Reference Price List (NHRPL). The NHRPL bears no relation to independently assessed practice costs which indicated a true reference price of at least 3 x NHRPL back in 2009.
In the case of the SA Private Practitioners Forum VS the DoH, 28 th July 2010, Mr Acting Justice Ebersohn found the NHRPL to be unreasonably low (did not meet costs of practice) and irrational, declaring it invalid and set aside.
This is the reason this practice charges more than the medical scheme rate and is therefore not contracted to any medical scheme, and thus is not a DSP (Designated Service Provider).
Reimbursement by medical schemes is based on scheme rules and the option the patient is on, therefore full payment of doctor’s fees is not guaranteed. Some schemes like Discovery and Momentum Health will usually pay the member directly and not the provider. The patient is responsible for the shortfall.
If surgery is decided upon, this practice will enter into an agreement with the patient and not the medical scheme prior to surgery.
We endeavor to assist the patient in navigating the complex medical scheme administration before and after surgery.