Dr Ajesh Maharaj
Rheumatologist
Westville - Durban

MB.BS.IMS.BHU(Varanasi);
H.Dip.Int.Med(SA);
FCP(SA) Cert in Rheumatology(SA)

Back to Top

Billing & Fees

Billing policy for the services rendered by this practice

This practice values our relationship with our patients and would like to ensure complete transparency on the patient’s possible medical healthcare costs associated with this practice. We hereby inform our patients, insurance companies & colleagues that the billing policy of this practice does not necessarily follow the different rates at which the various medical insurance companies reimburse at, or with that of colleagues or any price reference lists.

On 28 July 2010, after a High Court challenge, Judge Piet Ebersohn of the High Court made a ruling that there is no longer a legal standardised medical scheme tariff guideline, previously called the National Health Reference Price List (RPL). He declared the RPL or “medical aid rates” 2007 – 2009 null and void. He found the process by which the RPL and rate were determined to be “unfair, unlawful, unreasonable and irrational” and that this process resulted in tariffs that were “unreasonably low”.

From 2011, most of the medical schemes are now reimbursing at a percentage of THEIR “scheme rate” and both the percentage and value of the “schemes rate” vary from one scheme to another e.g. 2010 RPL rates plus 5% or 2010 RPL rates plus 6%.

Competition law requires each medical practice to disclose its billing practice which is determined according to the practice’s own costing structures and which is also in line with the provisions of the Consumer Protection Act. Some notes regarding the billing policy of this practice:

Telephonic consultations (tariff code 0130)

Repeat prescription will not be issued without a consultation with the doctor. Should a repeat

prescription be issued without a consultation, this will be charged for (tariff code-0132)

The writing of special letters and motivations with/without the patient (tariff code-0133)

The completion of Chronic medication forms (tariff code-0199)

The provision of medical reports and results for insurance purposes / assessments.

Guarantors & Patients, please note:

Repeat Prescriptions

Thank you for choosing this practice for your rheumatological needs.We value you as a patient. To avoid any misunderstandings, please note:

  1. Repeat prescription will not be issued without a consultation with the doctor.
  2. In the unlikely event that a repeat prescription is issued without a consultation, this will be charged for (tariff code – 0132 “consultation service e.g. writing of repeat scripts or requesting routine preauthorization without the physical presence of the patient (needs not be face-to-face contact (“Consultation” via SMS or electronic media included). Please ask for a quote.
  3. ALL FEES are to be settled once the script has been requested in CASH or by EFT (even if future consultation/visit is envisaged/booked. Regrettably, cheques are NOT accepted. Scripts will not be faxed or e-mailed or collected from reception until payments have been made.
  4. Fees are payable for every prescription.
  5. It is the responsibility of the MEMBER to submit the invoice to medical aid scheme and to follow-up on its reimbursement. Non-timeous submission may result in rejection of the claim. We look forward to meeting your rheumatological needs in the most efficient and professional manner.

Completion of Chronic Forms

Thank you for choosing this practice for your rheumatological needs. We value you as a patient. To avoid any misunderstandings, please note:

  1. Being a member of a medical scheme is an arrangement between the MEMBER and the SCHEME. The service provider (the practice and its doctor) is usually NOT part of that agreement.
  2. The onus & responsibility lies with the member to acquire the appropriate forms from their medical scheme.
  3. The completion of such forms is charged on Medical Aid tariff code: ‘0199 – Completion of chronic medication form with or without the presence of the patient’. PLEASE ASK FOR A QUOTE prior to sending the form to the practice.
  4. Forms are to be e-mailed / faxed to the practice on +27 31 2654897
  5. Please indicate the patient for whom the form is to be completed.
  6. The practitioner / doctor part of the forms will be completed by the doctor using the information from the patients’ file. In submitting the form to the practice, the patient automatically consents to their confidential details being revealed to a third party. Requests to use information that do not correctly reflect the circumstances of the case, are inappropriate.
  7. ALL FEES are to be settled immediately at the collection of such forms. Regrettably, cheques are NOT accepted.
  8. Should forms need to be faxed to the patient, this will only be done once payment has been received by EFT. Contact the practice for banking details or check top part of statement.
  9. Fees are payable for every form completed (even repeat motivations), irrespective of the approval by the medical scheme. (Errors on the part of the practice will not be charged for.)
  10. It is the responsibility of the MEMBER to submit the forms to the medical scheme and to follow-up on its outcome. We do not submit to any medical aid scheme. Non-timeous submission may result in rejection of the application.

We look forward to meeting your rheumatological needs in the most efficient & professional manner.

Guarantors & patients please note:

Writing of special letters & motivations.

Thank you for choosing this practice for your rheumatological needs. We value you as a patient. To avoid any misunderstanding, please note:

  1. Should a special letter/ motivation be issued with OR without a consultation, this will be charged for (tariff code 0133 – “writing of special motivations for procedures and treatment without the physical presence of a patient (includes report on the clinical condition of a patient) requested by or on behalf of a third party funder or its agent”).

    Please ask for a quote.

  2. ALL FEES are to be settled once the document has been requested in CASH or by EFT (see our banking details on our website under the “Contact us” page), even if a future consultation/visit is envisaged/booked. Regrettably, cheques are NOT accepted. Documents will not be faxed or e-mailed or collected from reception until payments have been made.
  3. Fees are payable for every completed document, irrespective of the success of the motivation. 4. It is the responsibility of the MEMBER to submit the invoice to medical aid scheme and to follow-up on its reimbursement. Non-timeous submission may result in rejection of the claim. We look forward to meeting you skin care needs in the most efficient and professional manner.

Guarantors & patients please note:

Completion of insurance forms and reports

Thank you for choosing this practice for your rheumatological needs. We value you as a patient. To avoid any misunderstandings, please note:

  1. Should an insurer request that a PMA (Personal / Physician Medical Attendant) report be completed for an insured individual / patient, this will be charged for. Please ask for a quote since this varies depending on the type of report requested and the complexity of the report.
  2. Although most insurers agree to pay for the costs of such reports directly to the practice, the patient shal l be ultimately liable for all fees regarding such reports.
  3. ALL FEES are to be settled once the document has been requested in CASH or by EFT, even if future consultation/visit is envisaged/booked. Regrettably, cheques are NOT accepted. Documents will not be faxed or e‐mailed or collected from reception until payments have been made.
  4. Fees are payable for every completed document, irrespective of its success.
  5. In their application to the insurer, the patient consents to such confidential information being released to the insurer.

We look forward to meeting your rheumatological needs in the most efficient and professional manner.