Undergoing a medical procedure is daunting. Far more daunting, however, is fully understanding the total cost of medical procedures.
In this blog article, we discuss a couple of important aspects to understand.

Doctors can charge whatever fees they like, provided they can motivate their fees

To enable healthy competition between medical practitioners in private practice, medical practitioners no longer have a guideline to use when determining their fees. Instead, they have been encouraged to follow the principles of a free market, essentially becoming businesses. This means that doctors only need to be able to justify their fees, but they can charge whatever they want to – there are no prescribed minimum or maximum rates.

The term “medical aid rate” is no longer relevant

In the past, you could enquire whether the doctor charges “medical aid rates”. This is no longer relevant.

What you need to know is whether you will have to pay a shortfall or co-payment to the doctor, in addition to the fee the medical aid is going to cover.

The rate at which your medical aid will pay your doctor is influenced by three factors: the medical aid you belong to, the medical aid plan or option you belong to, and whether your doctor is contracted in to your medical aid.

The reality is that very few doctors are contracted in to any medical aid – the rate at which most medical aids pay doctors just does not allow financial survival in an increasingly complex medical environment.

You need to determine what your financial liability is going to be, before you commit to medical treatment

You are entitled to ask, before committing to any medical treatment, exactly what the costs are going to be.

Professionally managed practices will disclose their fees to you, so that you can make an informed decision of whether you can afford to proceed with treatment. This is done by way of their doctor-patient contract, which you will need to sign when you visit the practice for the first time.

Make payment arrangements before you commit to treatment

If you are fully informed of the costs prior to surgery, it enables you to make payment arrangements with doctors prior to surgery taking place – ensuring that this does not become an additional burden after surgery, which will inevitably hamper your recovery.

Make sure you talk to the right person about fees

Find out who the appropriate person is to discuss fees with in the practice.

Doctors are not trained to discuss fees with their patients, and often shy away from this.

Most people become doctors because they want to make a difference in people’s lives, and although the monetary compensation for the service delivered is important, they feel uncomfortable having this discussion.

Determine whether there are other service providers going to be involved in your treatment, and ensure you know their costs too – especially if it is an emergency

In the case of an emergency, this is obviously not possible, however, you should know that most doctors do not charge the same rate as your medical aid, and that you can therefore expect to pay extra costs to all service providers involved.

Just to make sure, however, discuss your doctor’s fees with him prior to proceeding with emergency surgery whenever you can.

Don’t forget about “hidden” costs

It is important that you are aware of all the potential costs involved in your treatment:

• Follow up visits

Will you be expected to pay for follow up visits? Non-surgical specialties typically charge for every visit to the practice, so do some surgical specialties.

  • Other costs
    If you have a wound, you will require dressings. You will be required to pay for the cost of dressings required after surgery. In the case of complicated wounds, such as burns, this can be very costly.
    Other costs to consider include medication required after surgery – typically pain medication and sometimes antibiotics.
    If your wound becomes infected, a pus swab would be necessary, incurring additional costs from pathologists.

  • Other service providers
    As mentioned above, other service providers might be directly or indirectly involved in your medical care.

  • Hospital costs
    Not all hospital costs are necessarily covered by your medical aid – find out prior to commencing treatment whether there are any co-payments applicable.

In summary:

As member of the medical aid, it is your responsibility to know the rules of your medical aid, and especially of your medical aid plan. These two things determine whether your medical aid will cover medical costs.

You also need to ensure that you understand what the entire cost of your medical treatment will be, and what your financial liability will be.

Finally, communicate with the correct person in your doctor’s practice prior to surgery, to ensure you understand all costs, and make payment arrangements before asking your surgeon to place a scalpel in his hand.