Private hospitals in South African only accept payment in the form of medical aid or directly from the patient either in cash or by credit card. There is no other form of payment or guarantee of reimbursement that is usually accepted. It is essential that a person being admitted to a hospital understand the implications of having the necessary fund to secure treatment in a private hospital. With the variety of different financial products that are now available in the South African market, consumers can sometimes be mislead into believing that certain insurance policies will be accepted by private hospitals. However, these other financial products are often not accepted by most private hospitals in the country.
Medical Aid
A medical aid in South Africa is a registered non-profit organisation that guarantees payment for medical services to its members. Private hospitals deal directly with a medical aid to ensure that a patient can be treated and managed within the hospital environment. It is only applicable to essential medical services for the treatment and management of a disease or injury. Non-essential medical services such as cosmetic surgery and fertility treatments are not covered by most medical aids.
A private hospital will admit a medical aid member after acquiring an authorisation number from the scheme. Patients may be required to pay a small co-payment admission fee in cash. After treatment, the hospital submits the bill to the medical aid and is reimbursed directly by the scheme provided that the specific plan covers the facility in question, there are sufficient benefits available and that the patient was admitted for essential medical services. Doctors, medical specialists and allied health professionals have to claim independently from the scheme or patient.
Medical Insurance from R380 p/m
Covers GP, dentist & specialist visits, prescription medication, select tests & scans.Pregnancy (pre-birth) maternity visits and childbirth delivery in private hospital up to R70,000.
Private hospital care (illness-related) benefit up to R70,000 per event.
It is important to note that the medical aid member/patient is responsible for any shortfall in payment. This may be covered by medical aid gap cover.
Cash and Credit Card
Non-medical aid members are required to pay cash for hospitalisation in a South African private hospital. An upfront fee is payable at the time of admission which is usually several thousand depending on the reason for admission. A patient who cannot afford this admission fee or does not have sufficient funds available on their credit card can be refused hospitalisation and once stable they will be transported to a government hospital. These day, most private hospitals in South Africa accept all major credit cards and some will also accept foreign currency.
A private hospital may reserve a large amount on your credit card to cater for the services rendered while you are in hospital. This ensures that the hospital will be paid upon your discharge. Non-medical aid patients are presented with the final bill at the time of being discharged and have to settle the bill in full. The rates charged to non-medical aid patients may differ from the National Health Reference Price List (NHRPL) tariffs charged to medical schemes.
My husband is in a private hospital there in South Africa.
He does not have the funds to pay for his hospital bill…
What do we do?
He is an American citizen that was on his way yo the airport to come back to the United States, when he was injured in a car accident.
I appreciate your help of any kind to help get him home.
Hi Cindy. You will have to speak to the private hospital directly. If he is not on medical aid or does not have travel insurance, then the bills will have to be settled by you directly. Alternatively the private hospital can send him to a government hospital for free care.
Im pregnant and a member of medical aid but my gyner wanted cash of R3500 which i dont understand what is it for because the medical aid is paying on my behalf, while on top of that amount, she said i must pay R488.00 for consultation, i phoned my medical aid they said they paid all consultatation, while i was in shock of that,they send me a massege that i must pay the amount of R900 in cash on my next visit because my funds are finished, i asked them i just started using the medical aid, how come my funds are finished they didnt answer me. I phoned my medical aid again they confirmed that my funds are still there, no funds finished. I got angry and decided to change the doctor coz she is a thief, i realy ddnt understand that doctor, how does she work? Really!
Hi Nothando. Many private practitioners in South Africa are either contract out of medical aid (they will only take cash payments and not deal with your medical aid) or they charge rates above the medical aid tariffs. In both cases you will have to pay your specialist and then claim back from your medical aid, although you may not be reimbursed in full. If you are unhappy with the fee arrangement you should find a doctor who is contracted into medical aid and only charges medical aid tariffs. As for your medical scheme funds, you will need to discuss that directly with your medical aid.
My day to day funds are finished can i be admitted to a private hospttal
Hi Sipho. The hospital benefit is separate to your day-to-day funds. Provided that you have a legitimate medical reason to be hospitalised, your medical aid will still pay for your treatment in-hospital.
Hi I’m 4 weeks pregnant and I’m not on medical aid and want to have my baby at a private hospital. Will I have to pay the hospital fees cash or can it be paid on installment please help.thanks in advance.
Hi Thuli. You should discuss this with the private hospital of your choice. Usually the private hospital wants the payment upfront but this may vary among different facilities.
I just got into an accident and sustained a femur fracture. I need to do the operation asap but the cue at a government hospital is too long and I am thinking of going to a private hospital for the procedure. What are the for this , on average, if I am paying cash because I am not on medical aid.
Are the tariffs the same for medical aid and non medical aid patients in South African private hospital
I was admitted to a Mediclinic twice in December 2017/Jan 2018, for the same reason. For my first stay of 5 days, I was provided with an itemised bill, including all ward charges etc. I requested an account for the second stay and have been told I cant have one. The reason: “The system does not allow me to email a fully detailed account to you in this case as this account is not a Fee for Service (FFS) account – this is an Advanced Fix Fee (ADV. FIX FEE) according the billing guidelines – I cannot print or email a detailed account to you.” I have no idea what this means. both admissions were the same, for the same thing. I have always requested a full detailed hospital account and never been refused. What does this mean and am I entitled to a copy of the full hospital account as the patient?
Hi. Can i pay cash at a private hospital? I need arm surgery.
I need to make a co payment at a netcare hospital. Will they accept my Nedbank Amex card?
I am 16 weeks pregnant and not on a medical aid would like to deliver at a private. tried calling around and no medical aid will assist me . What other options are there for me ?
Hey Pamela, I’m in the same boat as you!
Kindly advise what you landed up doing ?
Hi,
My mom was admitted in hospital after going to the trauma unit with a very bad chest pain, she was diagnosed with a very bad lung infection. Our medical aid decided to quit on us after her 6th day in hospital stating that she had not disclosed her chronic illness.
We are now in debt of 51k.
How are we to pay this?
Is there a way or payment method?
Hi I get paid cash every week. How could i go about getting a good medical aid with a hospital plan? I’m also on chronic medication.
My husband Was let go from employment due to the company closing down and therefore we no longer have a medical aid, Last year 11 December, I was diagnosed with ovarian cyst that has to surgical removed, I want to have my procedure done in a private hospital, As per my conversation with my gynecologist , He told us that my surgical procedure could cost us R40.000 in our private hospital here in Ladysmith KwaZulu Natal, I wanted to know should I contact the hospital directly to find out about cash payment arrangements or should I trust what my gynecologist said as he works for the hospital, Please help I really need to know what I must do to make a right decision
Hi Zamankwazi. The gynaecologist would be familiar with the pricing since he/she mainly operates from that facility. Nevertheless you should still speak to the hospital as soon as possible. Your gynaecologist cannot be held liable if the hospital costs are higher and you will still have to pay for it.
As a private business, how much does it cost a phlebotomist taking blood for insurance purpose
I have seen a trend which worries me. Doctors (Gynaecologist) to be specific have a tendency of suggesting a patient take procedures that are more expecive than usual. I personally feel that they would recommend procedures such as C Section just because they are more expensive.
Which leads to my question, do doctors receive more income (Insentices) if they do such expensive procedures or recommend a patient to to take blood tests that are more expensive?
I may be wrong but I have seen such a trend in many private hospitals. My wife has just been sent to do these expensive blood test, even though there is no specific treatment if the outcome are positive.
My name is Nkuli i have a problem with my mother who need to do an oparation on a hip and i dont have a medical aids she is really suffering with pain she is straggling to walk it been 2 years now we even went to the public hospital but they are postponing date since from last year but now im willing to pay cash in a private hospital
Hi there
i wanted to know how do i take a short term insurance for my scar removal, i do have a medical aid but i heard that if forms part of cosmetic surgery despite what i feel and my drs got tired of motivating. I just need to buy a policy that will assist me.
Hi
I have a problem with my wisdom teeth and the dentist said I need to be booked for theater and I don’t have medical aid.
Do you know how much can this procedure cost in cash m in pain and my face is swollen
My mother, is admitted to a public/state hospital, however the services were poor from day one with no attention and lack of beds, is it possible to request a transfer to a private hospital and what are options available for payment
Hi my
My boyfriend is a non South African and had COVID 19 and had to be hospitalised in a private hospital. He payed a large amount of money and now not so long ago, the hospital sent him an email saying that he still owes R22000 after paying a whole of R140000 for hospital bill. But my question is how can they discharge him while he is still owing?
I am member of essentialmed medical insurance, my daughter is currently admitted in paeds ICU for 5 days and pre-auth was done by hospital were they send the insurance a quotation of ward fee including Doctor’s fee upon asking the Doctor how much she will need for her services and she confirmed the amount, to my suprise now the Dr. Keeps on calling me to tell me that the insurance can only pay R7500 to anaesthetic Dr while he claimed R23000 which the balance is said i must pay, are they right in saying i must pay anaesthetic Dr who was called in by the treating Dr to assist her with his services…i was never informed before hand that i will be liable for any shortfalls on the anaesthetic Dr.
My younger brother admitted to a public hospital the service is very much poor,is it possible to request transfer to private hospital without medical aid
Hi my son was admitted to a privated hospital in Durban my youngest son paid an amount of R27000 on admission because they could not get the medical aid to authorize at night.Will this monies be reimbursed to my son,cause my older son’s medical aid is paying the hospital bills.My older son past away after 5days at hospital.Please advice.
Good day
We have medical insurance and my husband was seen by a Urologis for a prostate biopsy. Two weeks after the biopsy he developed sepsis and was to be admitted to hospital. His treating doctor works in a certain hospital chain and when phoning the hospital they refused to admit him as they do not accept the medical insurance. My husband had to go to the casualty of the other group of private hospitals.
When contacting the medical insurance they say they do not have a specific contract with any hospital and will pay wherever my husband was admitted to. His situation is not resolved yet and he might be admitted again. We wish for his current doctor to treat him but the hospital where he works refuses to admit because of our insurance, which I might add has a trust index on hello peter of 9.2.
So my question is can a private hospital refuse to admit you even if they get a promise to pay from the insurance before admission.
What can I do.
Kind regards
Ronel
My boyfriend is in South Africa they had me sign documents cuz he was in a car accident trying to get back to the us cuz he’s a US citizen he’s in a private hospital out in South Africa. Before they work on him can they ask for partial payment before they even work on him or do I have to wait for the bill