Billing Policy

This practice values its patients and would like to ensure complete transparency regarding the patients possible medical costs when involved with the practice. The Department of Health (DoH) published the National Health Price List (NHRPL) in 2006 and this list was also adopted by HPCSA as the Ethical Tariff. The DoH later changed the NHRPL to reference price list (RPL). The publication of this list was followed by the publication of regulations relating to the obtainment of information and the processes of determination and publication of the NHRPL in 2007. In 2008, the HPCSA took a decision to scrap the Ethical Tariffs with effect from the date of publication Reference Price List (RPL) by the DoH. In 2010, the DoH RPL was reviewed, declared invalid and set aside by the High Court of South Africa (North Gauteng Division, Pretoria) (www.hpcsa.co.za). Therefore there is no longer a set medical tariff in South Africa and every medical aid chooses its own level of reimbursement. Therefore each medical practice has to decide what their cost structure and billing policy is.

Dr Sampie Smith Inc. Billing Policy:

  • First consultation: This is to be settled by the patient at the practice upon first consultation (Please contact practice regarding the amount as this changes every year).
  • Non-surgical follow-up consultation: Medical aid tariffs or Private tariff if patient is a private patient. Casualty consultation: This is to be settled by the patient at casualties upon first consultation (Please contact the hospital regarding the amount as this changes every year).
  • Surgical procedure follow-up: no fee within six weeks of your surgical procedure unless it is for a complication (e.g: wound infection, fluid collection etc.) or a new problem. Thereafter normal consultation fees apply. Please note that endoscopic procedures such as a gastroscopy and colonoscopy are non-surgical procedures.
  • Elective theatre costs: unless we have a contract with your medical aid, you will be charged medical aid tariffs with a co-payment depending on the theatre case. Please contact the practice regarding your co-payment for your procedure. You will be informed of the co-payment amount before your elective procedure.
  • Emergency and after-hours: unless we have a contract with your medical aid, all after-hour and emergency cases are billed at 250% of your scheme rate. If your condition happens to fall under the prescribed minimum benefit list your medical aid should cover the costs. Please feel free to contact us regarding this.
  • If we do not have a contract with your medical aid, your medical aid might not pay us in full for certain procedures. You are responsible to pay this amount. Dr Sampie Smith Inc. cannot be held responsible for any short payments or copayments applied by your medical aid.
  • Private patients will be billed according to our practice rate, please enquire on a quotation. A quotation is merely an estimation of the costs.
  • If we have a contract with your medical aid you will not be charged a cash fee for a consultation or follow-up unless youre day-to-day is depleted. It remains your responsibility to keep track of your limits in your day-to-day fund.
  • Feel free to ask us for a list medical aids that we have a contract with.
  • It remains the patient’s responsibility to read his/her medical aid rules. This is especially important regarding referral letters, medical scheme exclusions, authorization numbers for specialist visits and procedures, short payments and co-payments for procedures and endoscopic procedures.
  • It is the patient’s responsibility to acquire an authorization number for specialist visits and hospital admissions.
  • Please remember that according to the medical aids, an authorization number is not a guarantee of payment, your medical aid might choose to honour all, part or none of your final account whereby you as the patient will be responsible.
  • All outstanding accounts must be paid in full within 30 days from date of service. We reserve the right to charge interest and a service fee on accounts older than 30 days.
  • We make use of sms’s, emails, post and phone calls to inform you of outstanding accounts. You undertake to enquire about your account should you not receive one.
  • You are fully responsible for the payment of services rendered and should you not pay timeously, you understand that you will be liable for debt recovery costs.
  • It often happens that the medical aid pays the patient and then the patient has to pay Dr. Smith, the patient is then responsible to pay his account at Dr. Smith within 3 days of the money being deposited into his/her account. In failure to do so, a case of fraud can be opened at the local police.
  • It is your responsibility to phone the practice to book a follow-up consultation after any procedures.
  • It is your responsibility to phone the practice to enquire about your test results.