Helping Patients Understand Medical Aid & Specialist Billing

Medical aid processes, specialist accounts, PMBs, and co-payments can sometimes feel confusing and overwhelming for patients before surgery.

Our goal is to provide clear information and patient-focused guidance to help patients better understand their medical aid benefits, billing processes, and possible shortfalls before their procedure.

Medical Aid

Medical Aid Schemes Assisted

We work with a wide range of South African medical aid providers and regularly assist patients with authorisations, PMB queries, and specialist billing guidance before procedures.

Gap Cover

PMB & Gap Cover Guidance

Certain procedures and conditions may qualify under Prescribed Minimum Benefits (PMBs). We also help patients understand how gap cover may assist with specialist shortfalls not fully covered by medical aid.

PMB

Understanding Medical Aid Benefits

Medical aid plans, gap cover, PMBs, and co-payments can often feel overwhelming. Our goal is to help patients better understand their available benefits and possible shortfalls before surgery.

Focused Support

Patient-Focused Support

Our practice believes in clear communication, transparent billing processes, and helping patients feel informed and supported throughout their surgical journey.

Understanding Your Benefits Before Surgery.

We encourage patients to contact their medical aid provider before a procedure to better understand:

  • Authorisation requirements
  • possible co-payments or exclusions
  • Gap cover assistance options
  • Available hospital benefits
  • PMB eligibility

Why Co-Payments Happen

Co-payments can occur when:

  • Your medical aid covers only a portion of the specialist fee
  • Certain procedures fall outside your available benefits
  • Annual limits or savings have been exhausted
  • Your plan has hospital or specialist restrictions
  • The medical aid rate differs from specialist billing rates

Working With Leading Medical Aid Providers

Our practice regularly assists patients across a wide range of South African medical aid schemes and healthcare providers. While benefits and cover may differ between plans, we aim to help patients better understand their accounts, authorisations, PMB cover, and possible co-payments before treatment.

We believe in transparent communication, patient-focused guidance, and making the billing process as clear and stress-free as possible.

Get answers to all your questions you might have.

We understand that medical aid, PMBs, co-payments, gap cover, and specialist billing can sometimes feel confusing before a procedure. Our goal is to help patients better understand the process by providing clear information and patient-focused guidance whenever possible.

If you have questions regarding authorisations, accounts, billing, or possible shortfalls, our team will gladly assist and guide you through the process.

FAQ - Questions & Answers