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.
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.
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.