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Question
Posted by: Anonymous | 2009-05-12

not psych related, but pls advise

As Someone in the medical world, CB, can you advise me on how I can solve this with the Dr that treated me. He is not cooperating at all, I don' t know what to do. Is there a body I can complain and take this forward.

I was treated by a Dr at Garden City Clinic in Johannesburg in December 2008. He send a claim to my medical aid. When the medical aid rejected the claim, I called the medical aid to find out what was wrong. They told me it was because the doctors'  office submited the claim with only one innitial and they should correct it and resend the claim and it will be paid. I calle the doctor' s office and told them that and the lady I spoke to, agreed she would do that. This was obviously not done as I am now finding my name at the debt collectors. Should I not have been called first to sort this out before my name is forwaded to debt collectors? I am not refusing to pay for the services I received. I am happy to do so infact. I am told I should sort this out as the doctor did not treat the medical aid, but me. where should I start sorting it out when this was taken so far without my knowledge? My medical aid is still waiting for the claim to be resubmitted and they pay the amount, Shoud I really be blamed for this?

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Our expert says:
Expert ImageCyberShrink

PLEASE PLEASE PLEASE --- NO MORE ANONYMOUS !
Presumably you ought to discuss this with the doctor, and his secretary, and with your medical aid. YOu should not, obviously, end up blacklisted as a bad debtor for your medical aid having not paid him due to an error his office made and apparently did not correct efficiently. Did he send you further bills which you ignored ? No, you should not be blamed. I dont see why thedoctor and his ofice should have jumped the gun or why they blame you if they submited the claim incorectly and you informed them of how to remedy this.
I don't know whether the Medical Council section of the Health Professions Council in Pretoria can help with this

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2
Our users say:
Posted by: A Nonny Mouse | 2009-05-13

Hi Liza, you seem to know an awful lot about an awful lot !

Reply to A Nonny Mouse
Posted by: Liza | 2009-05-12

Unfortunately doctors usually make you sign a document that says that you are responsible for the account if the medical aid does not pay. Legally this makes you liable for the account and you can be blacklisted as a result even if it isn' t fair. Even if you didn' t receive any accounts or demands for payment, you are still responsible and yes, they can use debt collectors at any stage after 3 months. The problem is that most medical aids do not pay out claims if they are submitted more than 3 months after the service date. So if you' re unlucky, your medical aid might not even pay this bill anymore and legally you won' t be able to do anything about it. Trying to follow the legal route and blame the medical practice for not submitting the claim correctly will also be difficult and expensive.

My advice is to pay the bill yourself, and then try to claim it back from the medical aid. It will be the easiest and cheapest way to get out of the trouble.

Good Luck
Liza

Reply to Liza

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