PRIVATE FIXED FEE
Q & A:
1. What is included in the Mediclinic’s private fixed fee?
Mediclinic’s private fixed fee refers to a quoted amount for a specific procedure for the indicated number of days, which includes the hospital costs related to the clinical treatment received in hospital.
The private fixed fee excludes:
- Doctor fees such as treating provider and anaesthetist
- Associated provider fees rendered during the stay (e.g. radiology scans and pathology tests)
- Prosthetic devices
- Mobility Aids such as crutches, wheelchairs and similar items
- Take home medication
Note that the quotation will specify a potential additional daily fixed fee that is charged if the patient’s admission extends beyond the expected duration (length of stay cap).
2. How is the fee structured?
The Private Fixed Fees are made up of two components:
- A fixed component for a specified number of calendar days’ treatment in hospital. The specified number of calendar days are referred to as the Length of Stay Cap, which vary by Fixed Fee Category.
- A fixed daily fee (per diem fee) surcharge component for additional days’ treatment in hospital following the Length of Stay Cap. The fixed daily surcharge amount varies by Fixed Fee Category, however the amount per day remains the same within a Fixed Fee Category.
The Private Fixed Fee tariff structure is explained in the diagram below:
3. What does hospital cost refer to?
This refers to the actual costs of care including all nursing, theatre time, ward fees, medicine as well as other consumables (syringes, gloves, plasters etc). This cost does not include the doctor’s account or any radiology (x-rays or scans), pathology (blood tests etc) or prosthesis and take home medication.
4. What is meant by the length of stay cap?
Through the statistics available to the hospital, the standard duration of treatment for any particular procedure has been calculated. This is known as the ‘length of stay cap’, and reflects the timeframe up to which a patient’s admission will be covered by the fixed fee. Length of stay is calculated per calendar day and not per nights slept.
E.g. If you have been admitted on the Monday and discharged on Tuesday the same week, you have spent two days in hospital.
5. What is meant by privately paying patients?
Private fixed fees are available to patients who will be paying upfront for their surgery. This may include those without medical insurance, those whose insurance does not cover specific procedures or where medical aid benefits have been exhausted for the year.
6. Are the doctor’s fees included in the private fixed fee?
No. The private fixed fees do not include fees for the service provided by independent healthcare service providers and patients are advised to contact the doctors’ practices for a quotation for this component of the cost.
7. Is it only surgical procedures that are included in the private fixed fees?
No, Mediclinic has selected a number of scope procedures that the private fixed fee tariff model is also applicable to.
8. Do you have to apply for the fixed fee or does it automatically apply if I am admitted privately?
For a private fixed fee to be applicable, a quote is issued to the patient who then signs and accepts the quote before admission. The quote can be issued to any private paying patient that requests it.
9. If I have a procedure included on the private fixed fee list, but it is because of a medical emergency, is this tariff still valid?
Private fixed fees are not applicable to admissions through the emergency centre. They are applicable only to planned procedures included on the private fixed fee list.
10. If I have a complication from my procedure, is it included in the cost?
The hospital cost of treating any complication incurred during the admission is covered by the fixed fee. Should it be necessary that a patient stays longer than the length of stay cap, any related treatment will be included in the fixed daily fee (Per diem fee), regardless of the level of care being delivered.
11. If I am on a medical aid, will this fee be applicable to me?
This fee is only applicable to privately paying patients (i.e. those not claiming from their medical aid). In the case of a patient whose medical aid does not cover the procedure, or where benefits have been exhausted – the fee will be applicable as per an uninsured patient. The quotation will be issued for the specific procedure and the patient will pay upfront for the surgery.
12. What happens if my particular procedure is not on the list of private fixed fees?
At this point, Mediclinic has a set number of procedures on the list; however, we are constantly reviewing our admissions for private paying patients to identify the most appropriate procedures. This list will be updated on a regular basis.If the procedure is not on the Private Fixed Fee list, an estimate for the procedure can be obtained from the Accounts department.
13. What happens if a patient presents for a natural delivery but wishes to stay longer?
The patient will be admitted under the private fixed fee for NVD but will be subject to an additional per diem surcharge per day for the extended stay.
14. What happens if the patient presents for a natural delivery but the decision is made by the doctor/family to convert to caesarian section during the delivery process?
The patient can be provided with both natural delivery and C-section delivery quotes with notice that should the delivery become a caesarian section, the second quote will come into effect.
15. What if my procedure is cancelled?
If the procedure does not go ahead for clinical reasons, the patient will be liable for the cost of treatment received up until the point of cancellation, charged at Private Tariffs.
16. What if I am discharged earlier than the Length of Stay Cap?
If the length of stay is shorter than the LOS cap for the procedure, the Private Fixed Fee will remain the same.
17. What if I stay longer in hospital:
If the patient is admitted longer than the length of stay cap, any related treatment will be included in the fixed daily fee (Per diem fee), regardless of the level of care being delivered.