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.

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