Billing Information

This page provides some of the important information about how anaesthesia services are billed in private practice in South Africa. Please read it carefully to understand the process, your responsibilities, and how your medical aid plan may apply.

What is Anaesthesia Billing?

Anaesthesia billing is the process of charging for the services provided by an anaesthetist during a medical or surgical procedure. These charges include factors such as the complexity of the procedure, the duration of anaesthesia, and any special conditions that may apply to your case.

How Are Anaesthesia Costs Calculated?

Anaesthesia charges are based on a system called the Relative Value Guide (RVG), which assigns units to different aspects of the service:

• Base Units: Reflect the complexity of the procedure.
• Time Units: Reflect the length of time the anaesthetist provides care (e.g., per 15 minutes).
• Modifiers: Additional units for special circumstances, such as emergency surgery or medical conditions that increase risk.

The total units are multiplied by a Rand value (rate per unit), which determines the final fee.

How Does the Rand Value Work?

Every anaesthesiologist must set their own Rand value per unit, which reflects their expertise, practice costs, and market conditions.

• The Rand value chosen by each practice can differ, but is typically informed by current market trends and fairness.
• As a practice, we endeavour to charge fair and market-related fees that balance the high level of care we provide with affordability for our patients.
• Medical Aid Reimbursement: Medical schemes reimburse at their decided rate, which may differ from that charged by the anaesthesiologist. This might lead to a co-payment charged by the anaesthesiologist.

What Will I Be Charged For?

Your invoice will include:

• The anaesthetic service provided (e.g., general, spinal, or regional anaesthesia).
• The procedure details.
• The duration of anaesthesia care.
• Any additional fees for emergencies or special circumstances.

 Medical Aid Coverage

• Most medical schemes in South Africa cover anaesthesia costs based on their own fee schedules.
• If the anaesthetist’s rate is higher than the medical scheme’s reimbursement, there might be a copayment due.
• Pre-authorization: For elective procedures, you or your surgeon must obtain approval from your medical aid in advance.

 Billing and Payment Process

 There are two ways your anaesthetist may bill for their services:

1. Direct Billing: The anaesthetist submits the claim directly to your medical aid, and you pay any outstanding co-payments.
2. Patient Payment: You pay the anaesthetist when the invoice is received, and you claim reimbursement from your medical aid.

 What Are My Responsibilities?

 As a patient, you should:

• Check with your medical aid: Understand your plan’s coverage for anaesthesia, including tariff limits and potential co-payments.
• Obtain pre-authorization: Ensure your medical aid approves the procedure in advance, if required.
• Discuss costs with your anaesthetist: Request an estimate of the expected charges and any potential out-of-pocket expenses.

 Why Are There Co-Payments?

 A co-payment occurs when the medical scheme reimburses at a rate that is lower than that charged by the anaesthetist. This gap is not unusual because anaesthetists in private practice must set their own rates, while medical schemes often reimburse at a different rate.

 Challenges You May Encounter

• Unpaid Co-Payments: It’s important to plan for potential out-of-pocket expenses.
• Reimbursement Delays: If you pay directly, it may take time for your medical aid to process your claim.
• Unanticipated Costs: Emergency procedures or complications may increase the total bill.

 How Can I Avoid Billing Issues?

• Ask questions: Make sure you understand the costs and how your medical aid will contribute.
• Be proactive: Confirm with your anaesthetist if pre-authorization has been obtained.
• Communicate with your medical aid: Ensure they have all the necessary details for processing your claim.

 Who Can I Contact for Help?

• Your Anaesthetist’s Office: For questions about charges, billing, or payment methods.
• Your Medical Aid: For details about your plan’s anaesthesia coverage and reimbursement process.
• Billing Specialists: Some practices use billing companies that can assist you with claims and co-payment calculations.

 Key Takeaway

 Understanding how anaesthesia billing works can help you avoid surprises and ensure smooth processing of claims. If you have any concerns, don’t hesitate to speak with your anaesthetist or medical aid provider.

For more information or assistance, please contact your anaesthetist’s office or your medical aid provider directly.