Rift between BOMAID and doctors becomes chronic

MARANYANE NGWANAAMOTHO
Staff Writer | Friday January 27, 2012 00:00

'We have received a communication from representatives of the dental group, the medical practitioners' group and the optometrists' group of service providers informing the society that these groups will go ahead and implement the balance-billing method effective February 1, 2012,' said BOMAID CEO, Dennis Alexander.

'These service providers will, therefore, effective that date, charge tariffs that are outside the ones we had proposed and will demand our members to pay the balance.'

BOMAID said it did not agree with the proposed balance billing model because the method allows for service providers to charge any amount they desire, which might not be good for medical aid subscribers.

Alexander described BOMAID as a bargaining body that negotiates for better healthcare service prices with service providers on behalf of patients. The service provider enters in to an agreement to charge agreed prices, which benefits medical subscribers because they can pay lower for services in that way.

However, this will be taken away once the balance-billing model is adopted. In that event, patients would be the most affected as they would be expected to pay the balance, which they would have no way of estimating because they would have no idea how much the service provider would charge them from time to time, Alexander said.

'Ours is to protect our subscribers' money and negotiate for better prices,' he said. 'As individuals, subscribers would not have the power to negotiate for better prices.'

Alexander said that though they had initially offered a 6.5 percent increase for 2011 tariffs, they had since increased the rate to 10.4 percent, which health service providers still rejected. Instead, service providers want an increase of 20 percent for specialists and 13 percent for general practitioners.

Alexander said though service providers usually complained of late payments and none payments, BOMAID did not receive a single complaint of that nature last year.

'From our records, during the year 2011, we did not receive any complaint, written or verbal, from any of our contracted service providers about short payments or late payments,' he noted. He said last year, 75 percent of the service provider claims were paid within a turnaround time of 14 days.

'There are various reasons why the rest of the claims cannot be paid within that turnaround time, e.g. some claims are submitted by service providers with insufficient information,' he said.  'Claims that are paid outside the turnaround time are however mostly paid within 28 days of receipt.' Early this week, the medical practitioners, dentists and the optometrists petitioned BOMAID over tariffs that they say are the lowest in the region.

They also complained of bullying and intimidation by the BOMAID, saying it determined tariffs that did not favour them. The service providers said over the years they had absorbed such losses that they could no longer protect their private practice in Botswana. As a result, they would introduce the balance-billing model at the beginning of next month.

Until then, BOMAID may continue to set its tariffs while service providers would determine their prices individually, which could be lower or higher than the tariffs set by BOMAID.

Alexander said BOMAID would continue to pay according to its tariffs, the service providers would either increase or reduce their prices, and patients would pay the difference.