PMB cost implications ‘will be huge’
The potential cost implications of the legal interpretation of a Medical Schemes Act regulation that deals with the payment of PMBs is huge, the Board of Healthcare Funders (BHF) says in a statement released with the court application this week.
The BHF says if healthcare providers increase their charges for PMBs because they know schemes will have to pay whatever they charge, you, as a member of a scheme, could face an average contribution increase of 18 percent.
The BHF says a recent study by an administrator analysed doctors’ claims from January 2009 to July 2010 and found that if all doctors began charging at 300 percent of the now struck-down Reference Price List (RPL) tariffs, schemes’ claims would increase by 20.4 percent. This would translate into an 18-percent contribution increase, on average.
A further study, the BHF says, found that among doctors submitting PMB claims to a scheme that reimburses at 100 percent of the former RPL, only three percent charged more than the scheme’s rate.
However, the claims of a scheme that reimburses up to 300 percent of RPL showed that 48 percent of all practices charged this scheme more for in-hospital benefits than they charged the scheme that reimburses at 100 percent of RPL, the BHF says.