USEFUL INFORMATION AND GUIDELINES FOR PATIENTS
The South African Medical Association (SAMA), is the representative body for medical doctors in
This leaflet has been compiled in the interest of building and maintaining good doctor/patient relationships.
The following information is made possible
and compiled by the SAMA Coding Department
THE SOUTH AFRICAN MEDICAL
ASSOCIATION'S CODE OF CONDUCT
FOR DOCTORS STATES:
- When determining professional fees, consider the financial position of the patient and discuss the financial implications of treatment options.
- Respect the rights of patients, including the right to informed consent, which includes discussion and information relating to their condition so as to assist informed decision-making.
- Ensure that undue pressure from third parties does not influence patient management.
Did you know?
Your doctor may only write the details of your illness on a medical certificate after you have given your permission.
Compiled by the SAMA Coding Department
in co-ordination with the Human Rights, Law and Ethics Department
USEFUL INFORMATION AND GUIDELINES FOR PATIENTS
Medical Scheme Membership
- Always have your medical scheme membership card with you when you consult your doctor or other medical service providers. This will facilitate accounts processing.
- Check that your file is used when you consult your doctor and keep him/her informed of any changes in information, such as change of address and/or medical scheme options, etc.
- The SAMA Benchmark Guide to Billing for Medical Services, is the standard for doctors' fees in South Africa, and any lesser charge is a discount.
- Members of medical schemes qualify for a specific benefit portion towards medical services and procedures. This amount is based on the monthly contribution or scheme option that members subscribe to, and makes up approximately 1/3 of the SAMA recommended fee for doctors' services.
- When visiting your doctor he/she enters into a contract with you and not with your medical scheme, You remain responsible for payment of your doctor's account. Please check your monthly remittance advice from the medical scheme to see if your accounts have been paid. Schemes usually settle accounts within 30 days after receipt of the claim.
- Interest may be charged on outstanding accounts. You will have to pay this yourself, as your medical scheme benefit does not cover such costs. It is in your interests to pay the account as soon as possible.
- It is acceptable to negotiate fees for services or procedures with your doctor. Most practitioners are willing to give a discount on the SAMA recommended fees, but they are not obliged to do so.
- A doctor or his/her staff can give estimated costs for further treatment, but precise amounts can only be given after the actual service was rendered.
- Patients who are in arrears with their accounts may be 'blacklisted' on a dedicated list that is distributed among general practitioners only. This will not affect patients' general credit worthiness. However, civil action may be taken against patients who do not pay their accounts. A doctor may not put a patient's name on a general blacklist for non-payment of medical account(s).
- A doctor may not ask for an 'up front' payment before a service is rendered. This is only allowed in certain cases of cosmetic or corrective surgery where the patient has been informed about this arrangement beforehand. Some medical schemes require patients to pay a levy when visiting a doctor. This is not regarded as advanced payment.
- It is the patient's responsibility to obtain an authorisation number from the medical scheme before going for an operation or an expensive diagnostic procedure. Ask the doctor's staff for the code(s) to be used for your treatment to speed up your pre-authorisation process.
Cost of Treatment
- You are advised to negotiate fees with all the members of the surgical team when going for an operation. Do not assume that if the surgeon charges medical scheme benefits, that the assistant(s), anaesthesiologist and other service providers will do the same.
- A doctor may not provide your medical or personal information to a third party without your written consent. When signing any documents, make sure that you understand the contents of the document,
COMPLAINTS & ENQUIRIES
Hospital accounts: phone the Hospital Association of South Africa on 011 478-0156, fax 011 478 0410 or email: firstname.lastname@example.org
Unethical behaviour of doctors: submit complaints in writing to the Health Professions Council of South Africa, PO Box 205, Pretoria, 0001 or fax 012 328 5120.
Medical schemes: contact the Council for Medical Schemes on 012 431 0500 or fax 012 430 7644.
Nursing queries: phone 012 343 0121 or fax 012 343 5400
PO Box 74789, Lynwood Ridge 0040,
Block F, Castle Walk Corporate Park, Nossob Street,
Erasmuskloof EA 3, Pretoria 0153
Tel +27(0) 12 481 2000, Fax +27(0) 12 481 2100
(Association incorporated under section 21,
Reg. No. 1927/000136/08)