Practice Terms and Conditions and Billing Policy

Updated 6 April 2020.

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Welcome to my practice. Thank you for choosing to receive urological care from me. Please read the following carefully. It explains the billing and authorisation policy of the practice.

Preamble

  1. Pt wellbeing is the highest priority at this practice. I am a specialist urologist who spends time attending to emergencies, and in surgery. Although I will make every effort to be punctual, please be patient when visiting my practice. It is possible that I may run late or be delayed or have to reschedule appointments at the last minute.
  2. Medical aid cover is an agreement between a patient and a medical scheme. The patient remains responsible for payment for all services obtained at the practice. We encourage our patients to make sure that they have adequate medical aid cover and gap cover.
  3. The scheme rate of 100% is merely a representation of 100% of what the scheme is willing to cover. It has no relationship with the costs of running a practice. This practice is not able to offer services at 100% scheme rates.

Practice Terms and Conditions

  1. It is compulsory for patients to sign and agree to the terms and conditions, as well as the billing policy, to benefit from the services of this practice.
  2. Post-operative care is part of a multi-disciplinary team. Each member of the team will submit an account individually for any services provided. (I.e. specialists or allied medical service providers like physiotherapists).
  3. All patient and treatment information is treated confidentially and will not disclosed to a third party other than with a Court order or written consent from the legal guardian(s).
  4. As a patient of this practice, you give permission that medical information be shared for the purposes of running this practice, for example, provision of diagnostic codes and procedure codes to our billing bureau or your medical scheme.
  5. Should any dispute, disagreement or claim arise between the parties concerning the practice agreement, the parties shall try to resolve by mediation prior to litigation. This entails that the patient invites the practice in writing to a meeting and to attempt to resolve the dispute within 14 (fourteen) days from date of the written invitation. If the dispute has not been resolved by such mediation, the parties shall submit the dispute to the Arbitration Foundation of Southern Africa administered mediation, upon the terms set by the AFSA Secretariat.

Billing Policy

  1. The basic billing rate of this practice is 300%.
  2. First consulting fees must be settled at the end of the consultation and are the responsibility of the patient. This applies to both private and medical aid clients. These payments are claimed back from the medical aid by the member from available funds.
  3. All consulting fees exclude special examination fees, for example urinalysis, ultrasound, etc.
  4. Medical aid patients’ accounts for procedures, in and outside of our rooms, will be presented to medical aids.
  5. Patients are responsible for the payment portions not covered by their medical aids.
  6. A quotation can be provided on request to estimate the portion which will be covered by the medical aid.
  7. Any arranged payment contracts this practice has with any medical aid do not guarantee full settlement of accounts by the medical aid.
  8. Private patients must settle accounts immediately.
  9. Cash and major credit cards are accepted, but not cheques.
  10. Patients will be supplied with a detailed invoice to claim back payments made from their medical aid scheme.
  11. The following explains the 2020 rates that this practice bills at for commonly performed procedures (these are subject to change without notification):

Procedure

Amount

First consultation (30 minutes)

R1200.00

Follow-up consultation (15 minutes)

R600.00

In rooms ultrasound

R600.00

In rooms uro-flowmetry

R600.00

Preparation of a medical report on request

R800.00

Completion of insurance forms, etc.

R600.00

Preparation of a motivation (even if requested by the medical scheme)

R600.00

Telephonic / video consultation (15 minutes)

R600.00

Repeat prescription

R200.00

  1. Should an account be handed over for collection, the patient shall be liable for all attorneys and own client fees, collection charges and all disbursements. The account and payment of account is subject to the Prescribed Rate of Interest Act. The patient remains liable for additional interest accrued on accounts that have not been settled within 60 days. Patients are subject to inspection of and negative listing of credit information should accounts remain outstanding. The provided address is considered the domicile of patients.

Authorisations

  1. With the large amount of administration work required to obtain authorisation, this practice cannot obtain authorisation on behalf of patients, except in special circumstances.
  2. Patients are responsible to obtain authorization for consultations and theatre procedures.
  3. Once obtained, authorization numbers to be provided to the practice as soon as possible.
  4. Patients should not leave the practice without a copy of authorization forms with ICD 10 codes and procedure codes needed to obtain authorization from the medical aid.