Claims of inflated pricing by specialists dismissed

2013-01-17 00:00

THE South African Medical Association (Sama) has rubbished a media report that medical specialists charge inflated prices for prescribed minimum benefit (PMB) conditions.

Sama represents doctors practising in the public and private health sectors.

The association was responding to a media report that two major medical schemes allegedly have arrangements in place with a network of specialists, or designated service providers, to curtail huge amounts of in-hospital billing by specialists who allegedly shoot up their rates for PMB conditions.

Under the Medical Schemes Act, the schemes are obliged to cover the costs related to the diagnosis, treatment and care of any emergency condition, as well as a limited set of medical and chronic conditions.

Business Report reported on Monday that some medical aid members have had to make co-payments to specialists or for hospital admissions as the two schemes seek to maximise direct payment arrangements with doctors. The daily also reported that obscure billing structures experienced in the private health industry had often left members footing the bill.

Sama spokesperson Dr Mzukisi Grootboom said the allegations against their members were unsubstantiated.

“The report failed to inform the public that the PMBs were introduced to protect medical scheme members from scheme abuse, with the main aim being to protect the members from catastrophic and chronic diseases,” Grootboom said in a statement.

Grootboom said that before the introduction of PMBs, many medical aid members with these conditions ended up with no benefits by mid-year.

“We want to inform the public that a medical scheme benefit is only that — a benefit that a member is entitled to. It does not in any way equate to the cost of services offered by the doctors,” he said.

Join the conversation!

24.com encourages commentary submitted via MyNews24. Contributions of 200 words or more will be considered for publication.

We reserve editorial discretion to decide what will be published.
Read our comments policy for guidelines on contributions.

24.com publishes all comments posted on articles provided that they adhere to our Comments Policy. Should you wish to report a comment for editorial review, please do so by clicking the 'Report Comment' button to the right of each comment.

Comment on this story
0 comments
Comments have been closed for this article.

Inside News24

 
/News

Book flights

Compare, Book, Fly

Traffic Alerts
Traffic
There are new stories on the homepage. Click here to see them.
 
English
Afrikaans
isiZulu

Hello 

Create Profile

Creating your profile will enable you to submit photos and stories to get published on News24.


Please provide a username for your profile page:

This username must be unique, cannot be edited and will be used in the URL to your profile page across the entire 24.com network.

Settings

Location Settings

News24 allows you to edit the display of certain components based on a location. If you wish to personalise the page based on your preferences, please select a location for each component and click "Submit" in order for the changes to take affect.




Facebook Sign-In

Hi News addict,

Join the News24 Community to be involved in breaking the news.

Log in with Facebook to comment and personalise news, weather and listings.