Billing procedure for anaesthesia

General billing information

  • The fees charged and codes used by the anaesthesiologist fall within the guidelines of the Health Professions Council of South Africa.

  • The anaesthetic fee is based on a rate determined by each individual anaesthesiologist based on their training, expertise, experience and practice costs and do not relate to any medical scheme rate or the old NHRPL. (Competition Commission ruling 2004)

  • You will receive a completely separate account from the anaesthesiologist. (There will also be accounts from the surgeon, radiologists, pathology, physiotherapist, pharmacist and hospital.)

  • As all medical insurance companies offer cover at different rates your medical aid will reimburse you for your anaesthetic account at a rate based on the plan you have selected and the rules of your medical aid fund. This can vary from 45% (most 100% plans) to 100% (most 220% plans) of the amount charged. The total amount may not be covered by your medical aid. You will be responsible for the short fall.

  • An account may be sent to your medical aid to help with your claim, but you are still responsible for payment of your anaesthetic account to your anaesthesiologist and interest and all legal fees that arise from any accounts that are not paid in full within 60 days.

  • The cost of anaesthesia is dependent on the time taken and procedure complexity. As it is impossible to predict how long a procedure will take, this makes estimating the cost of an anaesthetic extremely difficult. An average cost estimate is therefore based on the average time taken for a procedure and assumes the procedure is of average complexity.

  • If the procedure takes longer than the estimated time the cost will increase according to the duration of the procedure.

  • Excluded are additional costs that will be incurred for modifiers such as: bone and joint surgery, obesity, paediatrics, elderly, ICU admission, pain relief techniques, blood pressure control, revision surgery and emergencies or cases not booked on routine lists.

  • If your BMI (body mass index) is greater than 35 kg/m2 you will be charged on additional 50% of the anaesthetic fee.

  • To calculate BMI = weight (kg)/(height(m) x height(m))

  • Explanations of the codes on the account can be obtained from The Board of Health Funders (011-537-0200).

  • Please feel free to contact us for a formal quotation.