Billing Consent

This Policy to be signed by the person who assumes financial responsibility for the account.  If the account is to be submitted to the Medical, Scheme, the main member of the Medical Scheme should sign this document.  Kindly tick and acknowledge that you have read and understood these provisions:

By signing the Van Huyssteen and Lennox Billing consent, I confirm that:

• This Practice charges the fees it regards as appropriate in terms of the experience, services and training of the professionals working in the Practice, as well as the cost-base of the Practice. The fees charged may not have the same rand value as your relevant Medical Scheme.

• In the event of a fee list not provided to you together with this Billing Policy, you are requested to contact the reception staff of the Practice as soon as possible during office hours for a complete quotation/exposition. 

• Fees may be increased on an annual basis and you will be notified of this by notice in the Practice.

• The Practice will provide you with a price of goods and/or services, and where it is unable to do so, it will provide a cost estimate to you. However, the duration of services, or the number of items used cannot always be exactly estimated.

• All accounts must be settled within 30 calendar days of the date on the account. Should you (the patient, if you are an adult, or the parent of a child-patient) not pay your account, we will give you notice of 90 calendar days, whereafter we will refer your account to an attorney/a debt collecting agency which will attract additional collection- and other fees. We reserve the right to charge interest of 2% per month on overdue amounts.

• By choosing this Practice, you consent to us submitting your account to your medical scheme.  However, it remains your responsibility to confirm that the medical scheme has received your account.

• Submitting an account to your medical scheme will result in disclosing the ICD-10 code (diagnostic code), should you wish for us to remove such diagnostic information from the account, the medical scheme will reject the claim and you will be held responsible. 

• If you do not want to submit any particular account to your medical scheme, please let us know before you leave this Practice.

• You must confirm with the Practice that the person indicated as belonging to the scheme as the principal member or dependent, is indeed a member with a valid membership at the date of visiting the Practice.

• Please note that pre-authorisation or scheme approval obtained, is according to schemes, no guarantee of payment by them.

• In many cases other health facilities, such as hospitals, clinics or other Healthcare Professionals will be involved in your healthcare (or the healthcare of your child). Such facilities and Professionals will charge their own fees in addition to the fees of this Practice if they also render healthcare services to you or your child.

• The Practice reserves the right to terminate non-emergency treatment due to non-payment of accounts.  Kindly contact the Practice should you wish to make payment arrangements.

• It remains at all times your responsibility to familiarise yourself with your specific coverage at your medical scheme as medical schemes and plan types differ. It is furthermore your responsibility to inform the Practice in the event of your medical scheme funds being depleted. 

• You hereby also declare that if you are not personally the main member of the medical scheme, he/she has been made aware that the account will be submitted to the medical scheme.

• It remains your responsibility to note when your appointments are scheduled and cancel sessions in the event that you may not be able to attend. Please respect the Dietitian’s time and cancel appointments at least 24 hours in advance, this will also give someone else the opportunity to make use of the service. 

• Please ensure that we always have your latest contact details to prevent you from missing any important communication from us. We may contact the person/s indicated on your personal information form if we cannot get hold of you and your account remains unpaid.

• You are encouraged to approach the Practice if you are experiencing problems with the payment of your account.

• I am aware of the following regarding the practice’ POPI Act policy:

• We collect and store the information about you in order for us to adhere to the administrative requirements of the practice

• We collect and store information about in order for us to continually assess, treat and manage your clinical best interest.

• We will use your personal information only for the purposes for which it was collected and agreed with you

• We may disclose your personal information to our service providers who are involved in the delivery of services to you (i.e for billing purposes). We have agreements in place to ensure that they comply with the privacy requirements as required by the Protection of Personal Information Act.

• We will, on an on-going basis, continue to review our security controls and related processes to ensure that your personal information remains secure.

• You have the right to request a copy of the personal information we hold about you.  Please note that any such access request may be subject to a payment of a legally allowable fee.