Billing & Medical Aid

How are anaesthetic services billed?

Anaesthetic services are billed separately from both the surgeon's and the hospital's fees. Each anaesthetist in our practice has their own dedicated billing contact to help with any questions about accounts.

How are accounts submitted?

When possible, we submit your account directly to your medical aid. Our practice is contracted only to Discovery Classic, and this arrangement, together with PMB (Prescribed Minimum Benefits), guides our billing rates. Your specific medical aid or insurance does not change the amount we charge, but it does affect how much is paid by the fund and how much shortfall you may need to pay personally.

Will there be a shortfall?

A shortfall happens when your medical aid does not pay our full account. A few things can influence this:

• The medical aid and plan you belong to
• The benefits you still have available
• The type and complexity of the procedure

Important points to remember:

• No matter your medical aid's rules, you are ultimately responsible for paying your account in full.
• Authorisation from your medical aid is not a guarantee that the full account will be covered.
• Being "covered at 100%" refers to your medical aid's own tariff rates and does not always mean that your whole account will be paid.

It is a good idea to speak to your medical aid before your procedure to understand your level of cover and whether you should expect any co-payments or shortfalls.

How are anaesthesia fees calculated?

Anaesthetic fees are based on several factors. One of the main ones is the time spent in theatre, which is not always easy to predict beforehand. Other factors include the specific techniques used to optimise your care during the surgery and your BMI.

Longer or more complex operations usually need more time, monitoring and resources to keep you safe and comfortable. This can increase the total fee. Because medical aids pay only a set portion of our account, this may affect the size of any shortfall you need to settle.

Need help or have questions?

If you are unsure about anything on your account or would like an estimate before your procedure, please contact our billing and accounts team. They are happy to explain your account, help you understand possible shortfalls, and guide you on what to ask your medical aid.