Medical Aid Funds Archives

2 Mar , 2017

Managing cash flow in a hostile administrative environment

cash flow, Medical Aid Funds, medical schemes Best Practice

There can be no doubt that the administration of the claims of one ambulance private ambulance service by a competing private ambulance is potentially anti-competitive. However, in the absence of intervention by auth...

29 Dec , 2016

Negotiating a sustainable tariff for your ambulance service

Monika Vermeulen

Medical Aid Funds, medical schemes, sustainable tariff Best Practice, Medical Aids

It needs to be emphasised private ambulance service owners or managers remain responsible for the final negotiation and acceptance of tariffs for the coming year. While many medical aid scheme representatives may rel...

29 Sep , 2016

Independent Community Pharmacy Association Challenges Closed DSP Networks and Co-payments

Monika Vermeulen

Council for Medical Scheme, Designated Service Provider, DSP, ICPA, Independent Community Pharmacy Association, Medical Aid Funds Medical Aids, South African News

The Independent Community Pharmacy Association (ICPA) recently won an appeal at the Council for Medical Schemes which will force the Council to declare the practice of closed Designated Service Provider (DSP) networks a...

5 Sep , 2016

Designated Service Provider Networks for EMS

Monika Vermeulen

Council for Medical Schemes, Medical Aid Funds, medical schemes Medical Aids

According to the Medical Schemes Act, 1998, Regulations, Chapter 3: Contributions and Benefits, 7: Definitions, a Designated Service Provider is defined as: “…a health care provider or group of providers selected...

30 Nov , 2015

Monika Vermeulen

fraud, Medical Aid Funds South African News

The prevalence of healthcare fraud involving collusion between medical aid members and healthcare providers is increasing, according to the Bonitas Medical Fund. According to estimates by the Healthcare Forensic Manag...

10 Oct , 2015

Bill you twice, shame on all of us

Bernard Allen

Business Ethics, EMS, Medical Aid Funds Best Practice

Instances of double and even triple billing of funds by a limited number of unscrupulous EMS providers are negatively affecting the image of the EMS industry. Such providers often invoice multiple funding sources for se...