Operations performed
- Laparoscopy
- Laparoscopic Cholecystectomy
- Laparoscopic Appendicectomy
- Laparoscopic Hemi-colectomy
- Laparoscopic low anterior resection
- Laparoscopic anti-reflux surgery Nissen fundoplication
- Laparoscopic anti-reflux surgery Anterior wrap
- Laparoscopic bile duct exploration
- Laparoscopic inguinal hernia repair - TEPP
- Laparoscopic incisional hernia repair - Underlay mesh
- Umbilical hernia repair with mesh
- Bariatric / Obesity Surgery - Laparoscopic Gastric bypass
- Bariatric / Obesity Surgery - Laparoscopic Sleeve gastrectomy
- Varicose Veins treatment- VNUS procedure, in-office sclerotherapy
- Endocrine - Thyroidectomy
- Endocrine - Adrenalectomy
- Endocrine - Parathyroidectomy
- Endocrine - Parotidectomy / salivary gland removal
- Amputations
- Anal fissure
- Anal fistula repair - fistulectomy, fistulotomy
- Colostomy and colostomy closure, ileostomy
- AP resection
- Gastroenterostomy / gastrojejunostomy
- Hemorrhoid surgery - THD or Transanal Hemorrhoidal Dearterialization , banding
- Breast surgery - Biopsy, Breast cancer surgery - mastectomy, breast conserving surgery
- Sympathectomy for Hyperhydrosis
- Laparoscopic splenectomy
- Laparoscopic Heller's myotomy for achalasia
- Laparoscopic adrenalectomy
- Vascular Surgery
- Lipoma and soft tissue resections
- Skin grafts and flap closures
- Wide local excision for melanoma and sentinel lymph node biopsy
- Anatomic segmental liver resection for colo rectal metastasis
- Lymph node biospy, incl laparoscopic lymph node biopsy
- Radical neck dissection
- Whipples operation - pancreatico-duodenectomy
- Rectocoele repair
- Sentinel lymph node biopsies
- Carpal Tunnel release
Procedures
- Gastroscopy in office - Cost R1100 - R 1500
- Colonoscopy - including polyp removal, biopsy, stenting
- Sigmoidoscopy
- PEG placement
- Access port placement
- Endoscopic stents
Billing Policy
This practice values our relationship with our patients and would
like to ensure complete transparency on the patient’s possible
medical healthcare costs associated with this practice. We hereby
inform our patients, insurance companies & colleagues that the
billing policy of this practice does not necessarily follow the
different rates at which the various medical insurance companies
reimburse at, or with that of colleagues or any price reference
lists.
In mid 2010, the High Court made a ruling that there is no longer a
legal standardised medical scheme tariff guideline, previously
called the National Health Reference Price List (RPL). In 2011 most
of the medical schemes are now reimbursing at a percentage of their
“scheme rate” and both the percentage and value of the “schemes
rate” vary from one scheme to another e.g. 2010 RPL rates plus 5% or
2010 RPL rates plus 6%.
Competition law requires each medical practice to disclose its
billing practice which is determined according to the practice’s own
costing structures and which is also in line with the provisions of
the Consumer Protection Act.
The tariff charged for healthcare services rendered in our practice
is as follows:
1. Private patients will be charged R500 per consultation and
procedures at 200%.
2. Follow-up visits are billed at R350
3. Insured rates of the patients’ scheme will be charged for
consultations and booked procedures according to a payment
arrangement signed with certain medical schemes, currently only
Discovery Classic plans.
5. Un-scheduled, Emergency and trauma fees are charged at 300% of
scheme rate.
For booked procedures, this practice will provide a patient with a
written quotation. It remains the patient’s responsibility to decide
or ascertain with their medical aid, what will/will not be covered.
Each quotation will provide a patient with the applicable procedure
codes & fees. A 5 day cooling-off period applies after the quotation
has been accepted.
Because of the varying and different benefits and exclusions on the
different medical aid plan options in the market, it remains the
patient’s responsibility to validate with their medical aid what
procedure codes and reimbursement tariffs are applicable on their
plan. Even if the patient’s medical aid covers a certain procedure,
it does not necessarily imply that the medical aid will reimburse
all the procedure codes charged by the practice. Please inform the
practice if there are any specific pre-conditions which you may have
to adhere to on your medical scheme plan e.g. medicine formularies,
preferred or designated service providers etc. These aspects can
have an influence on the fees you might have to pay, what portion
your medical aid will pay and any co-payments that may also be
applied.
Our practice will charge for any additional paperwork requested by
your medical aid e.g. pre-authorisations, motivation letters,
chronic medication forms or reports.
Even if the practice submits the account to a medical aid for
re-imbursement, the patient ultimately remains liable for the full
costs, the interest as specified in the National Credit Act, and for
any costs incurred in the recovery process in the event of the
account not being settled in full by the medical aid. Patients
should discuss all fees related to the other healthcare
professionals’ involved in the treatment plan (e.g. anaesthetist
charges, physiotherapy, pathology laboratory tests, x-rays, scans)
directly with them.
Should your medical aid not be able to clarify at which rates you
are insured at, submit your complaints to the
Council for Medical Schemes at
complaints@medicalschemes.com or contact them on, telephone 012
431 0500.
Should any of the above be unclear, or should you have any further
questions, please do not hesitate to ask the practice staff or
surgeon.