Billing Policy

1. Purpose

This Billing Policy explains how fees, medical scheme claims, and payments are handled at DR MICHAEL J LARIC ORTHOPAEDIC SURGERY ("the Practice"). By booking and attending an appointment, you agree to the terms of this policy.

2. Practice and Patient Responsibility

• The Practice is a private specialist practice and sets its own fees.
• Accounts remain the responsibility of the patient at all times, irrespective of medical scheme membership or benefit limits.
• The Practice will assist with medical scheme claims where possible, but cannot guarantee payment by any medical scheme.

3. Medical Schemes and Tariffs

The Practice is not obliged to charge medical scheme rates. Fees may be:

• In line with,
• Below, or
• Above

medical scheme tariffs, depending on the service and clinical complexity.

Patients are responsible for:

• Any shortfalls between scheme benefits and the Practice tariff.
• Any services not covered by their scheme (e.g. certain braces, consumables, or procedures).

4. Billing Method and Coding

Consultations, procedures, and operations are billed using standardised procedural and diagnostic codes (e.g. ICD-10 and relevant procedure codes).

Coding reflects:

• The clinical condition,
• The complexity of treatment, and
• Time and expertise required.

Accounts will not be altered to misrepresent diagnosis or services in order to obtain medical scheme benefits.

5. Estimates and Quotes

On request, the Practice can provide a written estimate for:

• Consultations,
• Surgical procedures,
• Assistants' fees (where applicable).

Estimates are not final quotations and may change based on:

• Intra-operative findings,
• Additional procedures required,
• Theatre time, implants, or consumables used.

Hospital, anaesthetist, radiology, and pathology accounts are separate and must be obtained directly from those providers.

6. Consultations (Rooms)

Initial and follow-up consultations are billed at the Practice's specialist consultation rates.

Payment terms:

• Payment on the day of the consultation is preferred.
• Where accounts are submitted to a medical scheme, any unpaid amount or shortfall remains payable by the patient.

7. Surgical Procedures

Pre-authorisation

• Where required, patients are responsible for obtaining pre-authorisation from their medical scheme.
• The Practice will provide necessary clinical information to assist but cannot guarantee authorisation or payment.

Deposits

For elective surgery, the Practice may:

• Require a pre-payment or deposit, especially where medical scheme benefits are limited or absent.
• Request full upfront payment for self-funded patients.

Assistants' Fees

• Where a surgical assistant is clinically required, an additional assistant's fee will be billed.
• This may not always be fully covered by the medical scheme.

8. Devices, Implants and Consumables

Some procedures require:

• Implants (e.g. joint replacements, plates, screws),
• Braces or boots,
• Specialised consumables.

These may be:

• Billed by the Practice, or
• Billed separately by the hospital or a third-party supplier.

Any items not covered or only partially covered by the medical scheme or insurer are for the patient's account.

9. Payment Terms

Due date: Payment is due on presentation of account, unless otherwise agreed.

Accepted payment methods:

• EFT
• Debit/credit card
• Medical scheme claim (where applicable)

Where accounts are submitted to a medical scheme: Any co-payments, levy, or shortfall is payable by the patient upon notification.

10. Interest and Collections

Accounts outstanding longer than 30 days may:

• Accrue interest at a reasonable rate as permitted by law, and/or
• Be referred to an external collection agency or attorneys.

Patients will be liable for:

• Reasonable collection costs,
• Tracing fees, and
• Legal costs on an attorney-and-client scale, where applicable.

11. Cancellations and Missed Appointments

Rooms consultations

• Appointments cancelled with less than 24 hours' notice may be charged a cancellation fee.
• Missed appointments ("no-shows") may be charged at up to the full consultation fee.

Surgical procedures

Theatre bookings cancelled without valid medical reason or emergency may attract:

• A cancellation fee for the Practice, and
• Possible hospital or anaesthetist cancellation fees (as per their policies).

12. Work-Related, Third-Party and Medico-Legal Cases

Cases related to:

• Road Accident Fund (RAF),
• Workmen's compensation,
• Third-party or liability claims,
• Medico-legal assessments or reports,

may be subject to separate fee agreements and usually require upfront payment.

Medico-legal reports, court appearances, and extended documentation are billed at specialist medico-legal rates and are generally not covered by medical schemes.

13. Refunds and Credits

Overpayments or credits will be:

• Allocated to outstanding accounts first, then
• Refunded on request to the patient or funder that made the original payment.

No refunds will be issued on:

• Correctly rendered professional services,
• Non-returnable consumables or custom devices.

14. Language and Jurisdiction

• All communication and documentation for the Practice are conducted in English (UK).
• This Billing Policy is governed by the laws of the Republic of South Africa.

15. Queries and Disputes

Patients are encouraged to raise any billing concerns promptly so they can be clarified.

Billing queries can be directed to:
Practice billing contact: Reception
Telephone: 076 589 9491
Email: reception@drlaric.co.za