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  • Dear Colleagues (4/21/2017) by Arthroplasty Society

    I had 3 Fedhealth insured patients consult me for TKRs. They had been patients of mine for
    years and wanted me to do their surgery. This was denied by Fedhealth as I was not signed up with ICPS.

    So I signed up in order to be able to treat these patients who had confidence in me.

    At that time I did not know that THE LAW, AS CONFIRMED BY A HIGH COURT
    DECISION, is that a Medical Aid cannot deny a patient treatment and are legally bound to
    pay for this treatment if the costs are the same as they would pay for with ICPS (or other 3rd
    party organisation). And asking for a penal co-payment (as with Discovery) is also illegal.

    In other words you do not have to be signed up with ICPS to treat Fedhealth (or other signed
    up Medical Aids) patients. You need only to get your clinic, prosthesis supplier and set your
    own fees such that it fits in with what Fedhealth would be paying to ICPS.

    Senior Council has opined that the ICPS system is illegal wrt to HPCSA rules and that Drs
    are potentially liable for investigation if signed up with them.

    The SAOA is meeting with the HPCSA to confirm this and find a legal way forward for the
    arthroplasty initiative.

    A further concern with ICPS is its prescriptive regulations and how patients can be cut out
    even after the event and are left with massive costs.

    I am thus asking all my colleagues who have signed up with ICPS ( and other initiatives) to
    join me in withdrawing. The very real possibility of ICPS and its signed up surgeons having
    a complaint against them being referred to the HPCSA must also be considered.

    By sticking together and supporting the 77% of the surgeons at the SAAS meeting who have
    refused to sign any global fee contract we can at last control our own fate and get a fee for
    our services that is in line with our expertise. With no one signed up there can be none of the
    present schemes that give us no say.

    Yours Sincerely,
    Dr Ponky Firer

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