Norman86 wrote
Bob, im on a medical aid. not a hospital plan. ?
The hospital, from what i gather, has been paid, its only the radiographers where im having the problem.
But im sure the excess should have come out of my hospital benefit anyway seeing as i was in hospital.
That would depend on the rules of the medical aid plan you belong to. The hospital and the radiographers are different practices. Just because you have x-rays, for example, taken in a hospital building doesn't mean you were in hospital. Radiography may be a separate benefit.
I can't comment much more because this is really all about the specific rules of the medical aid you belong to and also what motivations and clinical information were provided to the MEDICAL AID by the doctor who sent you for radiography and wether the medical aid considers the services you received appropriate for the diagnosis. Another issue may be wether or not the MRIs were performed whilst you were actually an in-patient in the hospital. Being under the physical hospital roof does not make you an in-patient.
EG a few years ago I was admitted to hospital with a DVT. It went something like this
1) I reported to the casualty department at the hospital with a very stiff, painful, swollen lower right leg.
2) They examined, suspected DVT and sent me to radiography for a scan
3) The scan indicated a DVT so they put me on a drip and called a specialist
4) The specialist examined me, performed his own scan and confirmed the DVT
5) The specialist then had me admitted to hospital
Now right up to point 5 I am not actually admitted to hospital. I am under the physical hospital roof but that's not the same thing.
The hospitals may not employ doctors that treat patients, so although they provide physical facilities for the casualty department, which must have doctors present, and although they may even provide the nurses and the medicines to the casualty department this is a separate practice and I am NOT in hospital by virtue of being in that casualty department. So all the scans, drips etc described above were administered whilst I was an out-patient.
Similarly the radiographers, pathologists etc may be under the same physical roof but are separate practices and you are not admitted to hospital simply because one or more of those practices provided a service to you.
Also note that they are separate practices. Separate bills, separate tariffs. The medical aid usually has agreements with the hospital, but these cannot be presumed to be extended to these other practices.
There are lots of possibilities and you should seek clarification from the medical aid. They might want you to pay upfront and then will refund you a lesser amount when you claim for the payments you made.
As regards an excess, there is no longer a fixed set of tariffs agreed between all hospitals and all funders. BHF still publish tariffs but the old agreement where everybody either contracted in to BHF tariffs or contracted out was deemed anti-competitive. So now medical aids decide what they are going to pay for a given service, and providers decide what they will charge. The two don't always meet and it can be the case that the medical aid decides to pay 50c for an elastoplast and guarantees to pay 50c, but the service provider is charging 55c. In this case the 5c difference is for your account. Or the funder may leave you to pay the full 55c and have you claim back from them, at which point they will pay YOU the 50c. Either way you are 5c out of pocket.
Whatever, make sure that you get proper statements showing what was billed, what the medical aid paid and what you had to pay as some of this may be tax deductible.
