by Dr David Green | Nov 10, 2020 | Uncategorised
One of the tools used by medical aids to manage the costs of Prescribed Minimum Benefits (PMBs) is to contract with doctors to form a network of doctors. In exchange for a higher fee from the medical aid and, perhaps, other benefits like direct or more rapid...
by Dr David Green | Nov 7, 2020 | Uncategorised
A number of Prescribed Minimum Benefits (PMBs) do not specify the treatment that would be required for the condition. This has resulted in medical aids taking different approaches to the funding of the treatment for these conditions. Some decline to fund...
by Dr David Green | Oct 9, 2020 | Uncategorised
On the 11th of September 2020, the Competition Commission issued a notice to stakeholders on the implementation of the outcome of the Health Market Inquiry. A key aspect of the notice was to inform stakeholders that a process has been initiated which will, ultimately,...
by Dr David Green | Jun 22, 2020 | Medical Schemes, PMBs
Many medical aid members find that, although their doctor and other bills are paid (or at least part paid) by their medical aid, the pathology bills are not paid at all. This is particularly puzzling in instances where the pathology tests were part of confirming...
by Dr David Green | Jun 1, 2020 | Uncategorised
When medical aids don’t pay a claim in full it can really hurt financially and is very frustrating for the member. The rules and regulations, benefit design, and hoops that the medical aid asks the member to through are confusing at the best of times. Sometimes...
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