Billing Policy

This practice charges private rates recommended by the ENT Society of South Africa and is not contracted in with medical aids.  Out of hospital rates are 165% and In hospital rates are 217%. Medical aids base their individual scheme rates (what they refer to as their 100%) on the National Health Reference Price List (NHRPL). The NHRPL was decided upon by the Department of Health and has not been increased since 2006. It does not correlate with the true costs of running a practice and has been estimated at least 3 x lower than required.

In the case of the SA Private Practitioners Forum vs the Department of Health (July 2010), Mr Acting Justice Ebersohn found the NHRPL to be unreasonably low and irrational, declaring it invalid.  Based on this judgement, the decision was made that practitioners are allowed to set their own private rates.

Reimbursement by your medical aid depends on the specific plan you are on and its rules and exceptions.  This means that it is not guaranteed that your bill will be covered fully by your medical aid.  The patient remains liable for any outstanding balances.

We highly suggest that you invest in a good GAP cover to help you with these outstanding costs.

We will gladly assist you where we can in navigating the complex medical aid administration.

For any queries regarding your account, feel free to contact our accounts department on 010 312 6519 or via email at services@qlpp.co.za