A Gauteng man has been fighting for weeks to get reimbursed after he realised he paid his doctor twice for the same medical treatment.
Sfanele Booi believes he is owed R600 by Dr Refiloe Moeletsi, an independent medical practitioner who operates from Curewise Medical Centre in Midrand.
However, Dr Moeletsi said he has reversed the R498.80 that BedMed paid on behalf of Booi and retained the R600 that he was charged for the same treatment.
“My gripe is that they double-billed me and to resolve their blunder, they reversed the medical aid’s payment and withheld mine. Making it worse is that I paid more than what medical aid paid. For me, it’s not really about the money; it’s about the principle,” Booi told Sowetan Consumer last week.
BestMed said in cases like these, doctors are not compelled to choose to refund medical aids over patients.
Booi’s troubles started in November after finishing consulting. His medical aid payment could not go through and he was advised by Dr Moeletsi’s receptionist to use cash and later claim from medical aid.
“In January, I noticed on my statement that the medical aid payment that could not go through after my consultation was actually paid. I realised that I double paid and I started calling Dr Moeletsi’s office seeking my refund. They kept sending me from pillar to post even though they admitted to owing me. The whole thing has been frustrating,” said Booi.
Responding on Dr Moeletsi’s behalf, the medical centre said it was not her intention to double-bill Booi.
“According to the office assistant who supports Dr Moeletsi, they had unsuccessfully attempted to process the medical aid claim for Mr Booi’s consultation. That is how he ended up paying in cash.
“It is not clear what technical issues led to the claim being processed again after that and we’re still looking into it through consultation with Dr Moeletsi’s office and the medical billing platform that she uses, Healthbridge. However, upon receiving the complaint from Mr Booi, the claim was reversed and his medical aid profile was credited,” said the centre.
Explaining the varying costs between Booi and BestMed, the centre said most healthcare practitioners’ consultation fees are not the same as the rates as set by different medical aid schemes.
“Some healthcare practitioners accept the medical aid rate even when it is less than their cash rates; others opt for co-payment to make up for the difference. This is why there is a difference in the medical aid amount claimed [and reversed] for Mr Booi and the cash amount he paid.
“In short, Dr Moeletsi’s practice accepts this specific medical aid’s rate of R498.80 for consultations. But her standard consultation fee is R600 when paid in cash,” said the centre.
BestMed spokesperson Madelein O’Connell confirmed the request for the reversal was received on January 27 and was successfully effected.
She said double dipping was not standard practice and in most instances where this occurs, it is typically due to an administrative oversight at the practice level.
“If a provider [doctor] made an error, they usually refund the member, as they were paid by both parties. They can also request a reversal from the scheme and the scheme can pay the member. The provider then has to refund the scheme as a reversal was done on his profile and he owes the scheme,” said BestMed spokesperson Madelein O’Connell.
“These matters are ordinarily resolved directly between the doctor’s office and the relevant medical aid or directly with the member. In instances where a cash payment has been made and a member raises a concern, our standard protocol is to initiate an internal investigation to ensure full due diligence.”
