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Medical treatment and informed consent






If you’ve ever needed medical treatment, you should have heard of “informed consent”. If you have never been introduced to this concept, we hope this article will empower you in this regard.

In all cases, except in a medical emergency, a medical practitioner or any other medical treatment provider must obtain your informed consent before treatment can commence.

Informed consent involves the patient acknowledging, in writing, that they fully understand all aspects of their procedure and giving their permission for treatment.

Informed consent needs to include the following:

  • Information about your diagnosis;
  • The range of diagnostic procedures and treatment options generally available to you;
  • The benefits, risks, costs and consequences associated with each option;
  • The availability of alternative treatment (including no treatment) and its implications, risks and obligations;
  • If the practitioner is charging more than the rate that your medical scheme will pay, and the details of the difference.

Why is informed consent necessary?

Healthcare is both complex and expensive. Most patients don’t always understand the risks and costs associated with the treatment they need, which is precisely why informed consent is necessary.

For patients who are medical scheme members, informed consent is especially a requirement if their doctor intends on charging higher rates than those paid by their scheme, particularly for treatments that are considered Prescribed Minimum Benefits (PMBs).

A medical service provider must therefore clearly inform the patient of the costs of the procedure or treatment and alert them to possible differences between the amount being charged and what their medical scheme might cover when claiming.

Unfortunately, hospitals and specialists are where the big expenses are, as there is no longer any legislation that controls how much they can charge.

Previously, we had the National Health Reference Price List (NHRPL), a reference list for what specialists should reasonably charge. Unfortunately, it was done away with. As a result all schemes, have negotiated fixed rates with the big hospital groups to contain costs as much as possible.

With informed consent, your doctors are legally bound to give you a quote for the treatment or procedure you need. Some medical scheme members choose to get two or three quotes so that they have a better idea of what a particular treatment might cost, before requesting authorisation from their scheme. A better price often means less of a payment shortfall, or none at all depending on whether the service provider charges within the scheme’s rate and which product the member has chosen.

At Cape Medical Plan we will run the quote you received from your attending medical service provider through our administration system and either agree to cover you in full, or provide you with reasons why we can’t cover the entire amount. The reasons could be anything from inappropriate treatment to overcharging.

Ultimately, informed consent is required by law and is an ethical requirement, which protects both doctors and patients. It protects patients against possible abuse and provides them with the information they need to ensure the best possible outcome is obtained, and it protects doctors from accusations of improper conduct or unethical behaviour.

At the end of the day, informed consent is good for all parties. If your doctor isn’t following this practice, please speak to them. It’s imperative to your health, your pocket, and their reputation.

Source: Cape Medical Plan
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