Preoperative assessment
A review of your medical history, risk factors and individual anaesthetic requirements before your procedure.
Patient information
Understanding Anaesthetic Billing
Learn what your anaesthetic account covers, how fees are calculated and what to check with your medical aid before your procedure.
Your account
Why will I receive a separate anaesthetic account?
Your anaesthesiologist is an independent specialist and will issue a separate account for the anaesthetic care provided during your procedure.
This account is separate from accounts that you may receive from the hospital, surgeon and other healthcare providers.
Your anaesthesiologist is responsible for assessing you before the procedure, planning and administering your anaesthetic, monitoring you throughout the procedure and overseeing your immediate recovery from anaesthesia.
H
Hospital
Facility account
S
Surgeon
Surgical account
A
Anaesthesiologist
Anaesthetic account
+
Other specialists
Where applicable
Understanding your fee
What does the anaesthetic fee include?
Your anaesthetic fee reflects the professional care provided before, during and immediately after your procedure.
Procedure fee
A fee based on the anaesthetic difficulty and complexity of the surgical procedure being performed.
Time-based fee
A time-based fee calculated according to the duration of your procedure (in 15 minute increments) and the anaesthetic care provided.
Additional care
Special monitoring, pain-management procedures or additional clinical care where required.
Possible additional fees
What can affect the final cost?
The final account may differ from an estimate if the length or complexity of your procedure changes, or if additional clinical care is required. Some examples of common modifiers:
Procedure and timing
- The total duration of the procedure
- An emergency or previously unbooked procedure
- Unscheduled travel to the procedure venue
- Additional care required because of an unexpected change
Patient and clinical complexity
- Existing medical conditions or functional impairment
- Age-related anaesthetic considerations
- A body mass index of 35 kg/m² or higher
- Admission to intensive care or the need for ventilation
Additional procedures and monitoring
- Epidurals or nerve blocks
- Postoperative drug infusions or PCA devices
- Arterial or central venous lines
- Goal-directed blood-pressure management
- Ultrasound-guided procedures
- Insertion of a nasogastric tube
Surgical considerations
- Non-typical patient positioning
- Orthopaedic procedure modifiers
- Operations involving the head or neck
- Other procedure-specific anaesthetic requirements
Professional fees
How are anaesthetic fees and rates determined?
Anaesthetic accounts use recognised professional coding principles, but the rate charged and the amount reimbursed by a medical aid are not necessarily the same.
Recognised coding principles
Southern Anaesthetics associates use recognised professional coding principles for anaesthetic services and comply with the professional and ethical requirements applicable to registered healthcare practitioners.
No single compulsory tariff
Medical schemes determine the benefits and reimbursement rates applicable to their plans, while individual anaesthesiologists determine the rates charged by their own practices.
Each associate sets their own rate
Each Southern Anaesthetics associate is an independent practitioner and sets their own practice rate. Rates and payment arrangements may therefore differ between associates.
Medical-aid cover varies
Some associates have direct-payment arrangements with particular medical schemes or plans, while others do not. Reimbursement depends on the patient’s individual fund and benefit plan.
What is the rate based on?
Anaesthetic fees reflect the specialist training, expertise and experience involved, the complexity and risk of the care required, the time spent providing the service and the costs of maintaining a safe specialist practice.
Concerned about a possible shortfall?
Confirm who your anaesthesiologist will be and request an estimate at least 48 hours before your procedure (where possible).
Request a Cost EstimateUNDERSTANDING SHORTFALLS
Why might there be a difference between what your medical aid pays and what a specialist charges?
Patients are sometimes surprised to find that the amount paid by their medical aid is not the same as the amount charged by a specialist. This difference is often referred to as a shortfall.
In South Africa, there is no single fixed “medical aid rate” that all specialists are required to charge. Specialists are independent practitioners and must determine their fees independently. Agreeing on one shared rate across a group of independent specialists could be considered anti-competitive price-setting.
In the past, industry-wide reference tariffs were used more widely. However, tariff-setting arrangements in the private healthcare sector were challenged by the Competition Commission, and the old system of agreed or recommended industry tariffs came to an end. Today, each medical scheme sets its own reimbursement rate or benefit limit.
This means your medical aid may pay according to its own internal scheme rate, while your anaesthesiologist’s fee may be different. If the scheme pays less than the amount charged, the difference may be payable by the patient.
What this means for patients
- Your medical aid’s approval of a procedure does not always mean all specialist fees will be covered in full.
- Different medical schemes and plans may reimburse at different rates.
- Anaesthetic fees are separate from hospital, surgeon and other provider fees.
- A shortfall may arise if your scheme pays less than the specialist’s fee.
- If you are concerned about cover, ask for a cost estimate before your procedure.
Medical-aid cover
What will my medical aid pay?
Medical schemes and individual benefit plans reimburse anaesthetic services according to their own rules and tariffs. The amount covered can therefore differ between schemes and plans.
Some Southern Anaesthetics associates may have direct-payment arrangements with certain medical schemes, while others may not.
Important:
Hospital or procedure authorisation does not necessarily
guarantee full payment of the anaesthetic account.
Before your procedure
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1
Confirm who your anaesthesiologist will be.
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2
Request an estimate before your procedure.
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3
Send the estimate to your medical aid.
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4
Ask what amount your benefit plan will cover.
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5
Confirm whether you may be responsible for a shortfall.
Preparing for your procedure
How the billing process works
Identify your anaesthesiologist
Confirm which Southern Anaesthetics associate will attend your procedure.
Request an estimate
Submit your procedure and medical-aid details at least 48 hours before the procedure.
Check your benefits
Ask your medical aid what portion of the estimated fee it will reimburse.
Review the final account
Check the final account and arrange payment of any outstanding balance.
Who is responsible for the account?
The patient and principal medical-aid member remain responsible for the anaesthetic account, including any amount that is not paid by the medical aid and/or gap cover.
The account may be submitted to your medical aid to assist with the claims process. You should nevertheless confirm that the claim has been received and arrange payment of any outstanding amount. The Southern Anaesthetic associate may offer a discount for early payment.
Private-paying patients should request an estimate at least 48 hours before their procedure (where possible) and confirm payment arrangements with the practice.
Southern Anaesthetic Associates’ accounts are administered by independent medical practice administrators and your anaesthesiologist may not know that you are experiencing any difficulties, unless you inform them of such.
Planning ahead
Request a cost estimate
A cost estimate can help you understand the likely anaesthetic fee and establish what your medical aid may cover.
Estimates are based on the information supplied before the procedure and may change if the duration or clinical complexity of the procedure changes.
Existing accounts
Find your account administrator
Each Southern Anaesthetics associate uses an independent medical practice administrator. Search for your anaesthesiologist below to find the correct contact.
Dr Adrian Burger
Account administrator: Fernanda
Dr Stan Davis
Account administrator: Ronell
Dr Johan Marais
Account administrator: Karin
Dr Peter Marwick
Account administrator: Angela
Dr Nick Meyersfeld
Account administrator: Ronell
Dr Neil Moodley
Account administrator: Ronell
Dr Chris Ngaka
Account administrator: Nicolene Barnard
Dr Guy Picken
Account administrator: Fernanda
Dr Rohan Pretorius
Account administrator: Fernanda
Dr Arthur Roberts
Account administrator: Claire
Dr Lance Thompson
Account administrator: Rone
Dr Dirk van Zijl
Account administrator: Larachelle
Dr Linda van Zyl
Account administrator: Fernanda
Dr Rouan van der Leek
Account administrator: Larachelle
Dr Kathryn Nieuwenhuis
Account administrator: Larachelle
Dr Zia Maharaj
Account administrator: Margit
No matching anaesthesiologist found.
Check the spelling or contact Southern Anaesthetics for assistance.
Planning an upcoming procedure?
Request an estimate to help you understand the likely anaesthetic fee.
Request a Cost EstimateStill need assistance?
Contact Southern Anaesthetics if you need help identifying the correct billing administrator.
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