Some hospitals expect patients coming in for surgery or dialysis to pay for their own tests
People covered by medical schemes no longer have to pay for negative Covid-19 tests done in the private sector, as long as they are referred by a doctor or nurse.
A Covid-19 test administered by Pathcare, Dischem, or Ampath costs about R850 and it takes two to three days to get a result. A test through the state-owned National Health Laboratory Service is free to the patient, but the backlog for results is about a week.
On 15 April, the
"All cases of Covid-19 are regarded as Prescribed Minimum Benefits (PMB) condition, and should be funded in full in line with the current
All consultations;
All clinically appropriate diagnostic tests including Viral PCR [polymerase chain reaction, the most widely used method of testing in
All clinically appropriate medication; and
Costs of hospitalisation including all complications and rehabilitation."
Medical schemes interpreted this to mean that coverage applied only to confirmed cases. As a result, all medical schemes decided that positive Covid-19 tests would be paid for by the scheme but negative tests would be paid for from a member's day-to-day account, or, if that account was exhausted, out of the member's pocket.
But on 8 May, following an amendment to the regulations under the Medical Schemes Act, the Council published an update to the PMB definitions. Now, if the patient has been screened by a health care worker, and is referred for testing by that healthcare worker, the test will "be funded from the risk benefit irrespective of the ... result".
However, medical scheme members are not yet out of the woods. Some patients coming to hospital for elective surgery, who have been told to get a Covid-19 test before admission, will have to pay for their own testing. Medical schemes will not pay for these tests if the patient has not been screened and referred by a health care worker, and patients at some hospitals are expected to pay for the tests themselves.
On 7 May,
"The spread of Covid-19 in our facilities by asymptomatic staff and patients remains the most significant risk we face and the most difficult to mitigate. To this end we are insisting that all patients are tested for Covid-19 prior to admission... The cost of the Covid-19 test is the responsibility of the patient or visitor."
"Patients attending oncology outpatient treatment (chemotherapy or radiation) at a
If a patient is tested and found positive, said Friedman, the patient "will be required to self-isolate until such a time that a negative test result is obtained, provided that the delay does not negatively impact the clinical outcome. If admission is absolutely required, the patient will be admitted into the red zone at the appropriate level of care."
Dialysis
Momentum medical scheme executive
Other medical schemes said the question was still being discussed. Lee Callakoppen, Principal Officer of Bonitas, told GroundUp that negotiations with the hospital groups were continuing. Dr
Fedhealth said the scheme would not pay for negative tests unless "clinical reasoning" deems it appropriate that patients are tested, in which case the tests would be "funded according to scheme rules and benefit structures."
In the case of dialysis or oncology, Fedhealth would pay. "Where a patient is diagnosed with a confirmed PMB oncology diagnosis, and they require testing as part of treatment progression ... these will be covered. This is because the patient has been confirmed to actually have the diagnosis."
Dr
Dr Stefan Smuts, Chief Clinical Officer of
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