MEDICAL AID SCHEMES AND RATES
The practice of Dr Evan Rabie is contracted with Bankmed, Bestmed, Discovery (excluding Discovery Keycare) and Fedhealth, and we strictly charge the contracted rates for these medical aid schemes.
For all other (non-contracted) medical aid schemes, medical insurance and private patients, this practice’s rates are based on Discovery Scheme Rate Option B (147%), with the exception of impacted 3rd molars (wisdom teeth)(1) and oncology or other pathology(2) related procedures.
1. Impacted 3rd Molars
Subject to plan/scheme rules, the removal of impacted 3rd molars for Bonitas, Camaf, GEMS, Medshield, Polmed and Profmed patients will be billed at the respective medical aid scheme’s rates. Discovery Scheme Rate Option B (147%) will apply for other procedures, including the removal of non-impacted teeth.
2. Oncology or other Pathology
Once the diagnosis of a cancer has been clinically confirmed, the patient qualifies for Prescribed Minimum Benefits (PMB) on South African registered medical aid schemes. PMB legislation requires all medical costs associated with a PMB condition to be paid in full, without copayments or deductions, provided that the services are rendered by a Designated Service Provider (DSP) of the subject medical aid scheme (which may include state medical institutions).
It is the responsibility of the member/patient to obtain the details of DSPs from their medical aid scheme and to ascertain if such DSPs perform cancer related procedures. Where a medical aid scheme does not have a DSP, or where the DSPs have confirmed in writing that they do not perform cancer procedures, this practice will assist the patient to have the PMB diagnosis registered with their medical aid scheme. In these circumstances, claims for the diagnosis, treatment and care of the patient’s condition will be claimed by this practice directly from the patient’s medical aid scheme, at rates agreed between the practice and the particular scheme.
If the medical aid scheme does have a suitable DSP to perform the cancer procedure and the member/patient voluntarily opts to solicit the services of Dr Rabie instead, the member/patient will be liable for the difference between the medical aid scheme rates and Dr Rabie’s fees.
CONSULTATIONS
Consultation and associated costs for contracted scheme members/patients will be claimed directly from the medical aid scheme, subject to plan/option/scheme exclusions and/or funds availability in Medical Savings Account (MSA).
It is incumbent upon the member/patient to consult with their medical aid scheme to determine any exclusions and availability of funds, prior to confirming an appointment with this practice.
The member/patient will remain liable to settle any amount not covered by their medical aid scheme.
For all other non-contracted medical aid schemes, medical insurance and private patients, payment of consultations and associated costs are strictly payable by the patient/member prior to leaving the practice following an appointment. The member/patient will be provided with the necessary information to claim back from their medical aid.
PROCEDURES
This practice will provide the rates, ICD10 and procedure codes required by medical aid schemes for authorisation purposes.
It is the member/patient’s responsibility to obtain a written and costed authorisation / confirmation of benefits from their medical aid scheme, reflecting amounts not covered in terms of their plan/scheme. Only authorisations/benefit confirmations reflecting the amounts covered/not covered per procedure code, will be accepted.
Procedures for medical insurance and private patients are payable by the patient
Authorisations/confirmation of benefits and proof of payment for copayments/payments to reach this practice at least 7 (seven) days prior to the date of the procedure.
All procedure appointments not complying with the requisite conditions will be cancelled from the diary/theatre lists.
