If you belong to medical scheme (A) could they be paying providers at a different rate to medical scheme (B)? Shouldn’t there be a standard tariff structure? Only in a perfect world! There actually was a workable framework called the National Health Reference Price List (NHRPL) that all the medical aid schemes used as a yard stick to set tariff structures but in July 2010 the High Court declared it null and void (It might be seen to be collusion if medical schemes get together to discuss tariffs & pricing). Now it seems the Registrar (and I did give the Council for Medical Schemes a call to confirm this) gives the medical schemes guidelines in terms of pricing. But they are only guidelines and medical schemes can and do set their own pricing parameters.
What does this mean for medical aid members?
With no valid guide on which to base their tariff structures, schemes have been left to come up with their own tariff and rates structures!
Don’t you think greedy healthcare providers will look to capitalize on the situation?
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Until next time.
The InsuranceFundi Team