Patients to get scheme permission

The majority of medical schemes require their members to obtain authorisation before receiving services from healthcare practitioners registered under the Health Professions Act.

While acting in the best interest of their patients, some practitioners offer to assist them with obtaining authorisation from their medical schemes for services to be rendered. Unfortunately, this has left members of medical aid schemes with the impression that it is the healthcare practitioner’s responsibility to obtain permission from their medical aid schemes.

Council has received numerous complaints against practitioners emanating from this misconception and as a result, some patients have experienced financial losses.

Patients who are members of the medical schemes are advised as follows:

  • Healthcare practitioners have no relationship with the patient’s medical scheme except that which is provided for in managed healthcare arrangements;
  • The responsibility for obtaining authorisation for treatment or services to be rendered lies with the member of the medical aid after receiving prescribed information from the patient’s treating practitioner;
  • Patients are also reminded that it is their responsibility to ensure that the authorisation obtained from their medical scheme covers the scope of their treatment and services to be rendered;
  • Patients should communicate with the practitioner concerned, especially when there is limitation to the authorisation given.

Last Updated on 9 Sep 2016 by HPCSA Corporate Affairs