Everyone wins with health care provider networks
We all want to get the most out of our medical aid schemes. The key to achieving this is by understanding and using your medical scheme benefits to their best effect.
An excellent way of maximising your benefits is by using the health care provider networks or designated service providers (DSPs) specified in your particular medical scheme, says Peter Jordan, Principal Officer of Fedhealth.
“These networks have been created with scheme members and health providers’ interests at heart,” explains Jordan. “These partnership models ensure that medical scheme members have access and cost certainty when visiting one of the designated service providers (DPS) and this ensures that their scheme benefits are maximised.”
Jordan goes on to explain how these partnership models or networks of DSPs benefit all involved. Healthcare providers, who can opt to belong to various networks, gain because they are ensured cost-certainty in terms of the payments they will receive from the medical schemes, and the schemes in turn are able to anticipate future healthcare provider related costs via these models. “Partnering with healthcare providers keeps costs stable by alleviating unanticipated spikes in healthcare costs that could jeopardise the financial stability of medical schemes going forward.”
A medical scheme like Fedhealth has three categories of DSPs or healthcare provider networks:
- GP Partnerships (there currently are 4 579 service providers on this specific network).
- Specialist Partnership (there are currently 3 629 specialist service providers on this network)
- Pharmacy Partnership (1 739 pharmacies currently listed)
Jordan suggests that members of medical schemes ensure that they use a DSP or health provider within their scheme’s network in order for their prescribed minimum benefits (PMBs) to be paid in full.
“Eighty one percent of our claiming beneficiaries are making use of our GP partnership,” says Jordan. “It really is in your best interests to ensure that your treating doctor belongs to the specialist or GP partnership or, to make use of a DSP for all consultations and treatment because this extends your benefits and reduces out-of-pocket co-payments,” says Jordan.