In the health care industry, the health care professional (physiotherapist, doctor, etc.) has the discretion to charge their own price for their service(s). For example, Physiotherapist A charges R 750 per session, while Physiotherapist B asks R 950 per session.
In addition, each Medical Aid agrees to their own tariff for each treatment, technique, evaluation, test and procedure. Let’s argue that a Medical Aid agrees to pay R 750 for a physiotherapist session. This R 750 is considered by the Medical Aid as ‘covering 100% of the cost for a physiotherapy session’.
Considering the previous example; When you receive treatment from Physio A there will be no additional costs (no co-payments) because the full amount will be covered by the Medical Aid. The treatment costs R 750 and the Medical Aid provides R 750 for the treatment.
If you go for treatment at Physio B, the cost of the treatment is R 950 but the Medical Aid only covers R 750. R 200 will not be covered by the Medical Aid. Who pays the additional R 200? You! And that additional cost’s name is called ‘co-payment’. When you visit Physio B, you will have to pay a R 200 co-payment (additionally/extra) for the session.
Some medical practitioners have contracts with Medical Aids for agreed upon rates, but still charge a co-payment – be aware of this. I tell you this to warn you of some loopholes in the health care services industry. We (at Cilliers & Swart) run an honourable and honest practice. To be clear: we don’t charge co-payments and there are no extra, no additional, no hidden costs when you come for treatment.