Useful information and guidelines for patients

The South African Medical Association (SAMA), is the representative body for medical doctors in South Africa.

This leaflet has been compiled in the interest of building and maintaining good doctor/patient relationships.

Compiled by the SAMA Coding Department in co-ordination with the Human Rights, Law and Ethics Department

The following information is made possible and compiled by the SAMA Coding Department

For all SAMA Guidelines and Policies as approved by SAMA Board of Directors, please click on the link below
SAMA Guidelines

THE SOUTH AFRICAN MEDICAL ASSOCIATION'S CODE OF CONDUCTFOR DOCTORS STATES:

CODE OF CONDUCT - SAMA MEMBERS

• When determining professional fees, consider the financial position of the patient and discuss the financial implications of treatment options
• Respect the rights of patients, including the right to informed consent, which includes discussion and information relating to their condition so as to assist informed decisionmaking.
• Ensure that undue pressure from third parties does not influence patient management

Did you know?

Your doctor may only write the details of your illness on a medical certificate after you have given your permission.

USEFUL INFORMATION AND GUIDELINES FOR PATIENTS

Rights and responsibilities of doctors and patients

Medical Scheme Membership

• Always have your medical scheme membership card with you when you consult your doctor or other medical service providers. This will facilitate accounts processing.
• Check that your file is used when you consult your doctor and keep him/her informed of any changes in information, such as change of address and/or medical scheme options, etc.

Doctors' Fees

• SAMA does not have price/tariff guidelines as we are prohibited by law to pronounce any tariffs. The doctor has to determine his/her own tariffs based upon his/her own practice costs. SAMA does not prescribe any rates.

Contract

• When visiting your doctor he/she enters into a contract with you and not with your medical scheme, you remain responsible for payment of your doctor's account. Please check your monthly remittance advice from the medical scheme to see if your accounts have been paid. Schemes usually settle accounts within 30 days after receipt of the claim.

Interest

Charging of Interest

1. 1. The interest that can be charged must be expressed in percentage terms as an annual rate which rate must not exceed the applicable maximum prescribed rate as determined by the Minister. The aggregate interest may also not exceed the unpaid balance of the principal debt under the credit agreement as at the time the default occurs. The interest rate for incidental credit agreements is 2% per month.
2. 2. Default administration charges can be charged provided they do not exceed the applicable maximum for the category of credit agreement concerned. These charges may further only be imposed if the consumer has defaulted on a payment obligation under the credit agreement and if proper notice has been given (see Debt Enforcement below)
3. 3. Collection charges which may not exceed the maximum for the category of credit agreement and provided that proper notice has been given (see Debt Enforcement below).

In respect of an unpaid amount, recovery of a fee, charge or interest can only occur if the credit provider has disclosed, and the consumer has accepted, the amount of such fee, charge or interest, or the basis on which it may become payable, on or before the date on which the relevant goods or services were supplied.

Discount

• It is acceptable to negotiate fees for services or procedures with your doctor. Most practitioners are willing to give a discount for services rendered, but they are not obliged to do so.

Estimates

• A doctor or his/her staff can give estimated costs for further treatment, but precise amounts can only be given after the actual service was rendered.

Debt Enforcement

• The practitioner may not commence any legal proceedings against a consumer to enforce the agreement before first providing a written notice to the consumer drawing that consumer's attention to the default. Once the notice has been given to the consumer and the consumer either ignores the notice or rejects any proposals for settlement that may be contained in that notice and after 10 business days have elapsed, proceedings can be started.

Upfront Payments

• A doctor may not ask for an 'up front' payment before a service is rendered. This is only allowed in certain cases of cosmetic or corrective surgery where the patient has been informed about this arrangement beforehand. Some medical schemes require patients to pay a levy/co-payment when visiting a doctor. This is not regarded as advanced payment.

Pre-authorisation

• It is the patient's responsibility to obtain an authorisation number from the medical scheme before going for an operation or an expensive diagnostic procedure. Ask the doctor's staff for the code(s) to be used for your treatment to speed up your pre-authorisation process.

Cost of Treatment

• You are advised to negotiate fees with all the members of the surgical team when going for an operation. Do not assume that if the surgeon charges medical scheme benefits, that the assistant(s), anaesthesiologist and other service providers will do the same.

Personal Information

• A doctor may not provide your medical or personal information to a third party without your written consent. When signing any documents, make sure that you understand the contents of the document,

Complaints & Enquiries

• Hospital accounts: phone the Hospital Association of South Africa on 011 784 6828, fax 011 784 6825 or email: contact@hasanet.co.za
• Unethical behaviour of doctors: submit complaints in writing to the Health Professions Council of South Africa, PO Box 205, Pretoria, 0001 or fax 012 328 5120.
• Medical schemes: contact the Council for Medical Schemes on 086 112 3267 or fax 086 673 2466 or email: complaints@medicalschemes.com.
• Nursing queries: phone 012 420 1000 or fax 012 343 5400 or email: registrar@sanc.co.za

PO Box 74789, Lynwood Ridge 0040,
Block F, Castle Walk Corporate Park, Nossob Street,
Erasmuskloof, Pretoria 0181
Tel +27(0) 12 481 2000, Fax +27(0) 12 481 2100
www.samedical.org
(Association incorporated under section 21,
Reg. No. 1927/000136/08)