Becoming part of the Discovery Network of approved Physiotherapists
Discovery Health approaches certain key health care professionals (in this case, Cilliers & Swart Physiotherapist) and negotiates a tariff for every treatment that can be provided for by the health care professional. An agreement is reached between the health care professional and Discovery Medical Aid concerning the fee the Medical Aid is willing to pay. This agreement allows Cilliers & Swart to be listed as an approved service provider to patients on Discovery Medical Aid plans.
What’s in it for Discovery Medical Aid members?
The negotiated guidelines between us (Cilliers & Swart) and Discovery protect you (the patient) from paying any additional ‘co-payments’ when coming for treatment at any of our practices. Discovery can increase their rates for certain treatment techniques and can refuse to pay for certain unnecessary expenses. We are fully aware of and accept Discovery’s policies, terms and conditions. This means that we know how much Discovery will pay for your treatment. More importantly, this allows us to provide you with the best possible care within the cover provided to you by your Discovery Medical Aid plan without charging you additional costs or ‘co-payments’.
What’s in it for us?
Forming part of Discovery’s Network of Physiotherapists, ensures that we (Cilliers & Swart) receive timely payment from Discovery Health when we treat their members. Discovery pays us within 7 days of your treatment. This timely payment is very important because health care professionals wait for payment days after service(s) have already been delivered. Sometimes, we can wait up to 30 days before receiving payment from other Medical Aids. In some cases, we’ve also found that Medical Aids delay payment for as long as possible. Considering these situations, you can imagine how grateful we (as a health care service provider and employer of health care professionals) are for Discovery’s willingness to work together with us in building and enhancing health care services rather than working against us.
Visit a Discovery Network Physiotherapist in Pretoria
Cilliers & Swart Physiotherapy is part of the Network of health care professionals providing health care services to members of Discovery Health. This means that, if you decide to visit a Cilliers & Swart Physio practice for treatment, we can claim your treatment expenses directly from Discovery. Our practice offers treatments dealing with muscle, ligament, tendon, nerve and bone pain.
As registered Discovery Health Physios our tests, diagnosis and treatments are completely covered by a patient’s Discovery Medical Aid plan. After a treatment session, we claim any costs relating to the treatment directly from Discovery Health.
100% Discovery Medical Aid Rates
We understand patients’ concerns when it comes to payment and planning for any future medical expenses. Rest assured that when we submit a claim to Discovery, there won’t be additional ‘hidden payments’ or ‘unforeseen costs’. We only claim 100% of the allowed scheme rate, nothing more.
What is a co-payment?
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.
No Co-payment, Zero, Nothing, Nada
If your Discovery Medical Aid plan’s “Medical Savings Account” has funds available or your plan’s “Day-to-Day benefits” includes physio treatment – there will be no hidden costs. Since each Physio in our practice is part of the Discovery Network, we confidently promise you that we won’t charge you any “co-payments” or extra costs outside of your Discovery Medical plan’s provisions. This means we won’t claim unnecessary consumables, tests or scans. Everything is covered by your Discovery plan.
Cilliers & Swart
World Class Medical Aid Physiotherapists
Discovery Physio Rates claimed from your plan’s Savings Account
If your Discovery Medical Aid plan does not cover physio treatment (as a benefit), our claim will be deducted from your plan’s “Medical Savings Account” or your “Day-to-Day benefit”. As a precaution, we recommend patients check the balance of their funds before coming for treatment.
Do you just walk into a store and buy everything you want without checking how much money you have available? No. Any responsible person first checks their budget and then buys.
Discovery employs many consultants, sales representatives and admin staff to assist you in getting the information that you need. Ask your Discovery Medical Aid consultant to confirm the balance of your “Medical Savings Account” to ensure that you have funds available for your planned treatment. Knowing your Medical Aid plan’s provisions can save you time, money and frustration. You have the right to know and we’re encouraging you to find out.
If you have a Hospital plan
A hospital plan may not provide Discovery Medical Aid cover for Physio treatment. Hospital plans usually only cover costs of treatment while you are hospitalized. This means that you can’t use a hospital plan to pay for physiotherapy treatment at our practice. Our treatments can be covered by funds available in your “Medical Savings Account” or “Day-to-Day benefits” as part of your Discovery’s Medical Aid plan. If your hospital plan does not have a “Medical Savings Account” or “Day-to-Day benefits”, you will have to pay cash.
