Medi-Clinic, medical aids agree on tariffs

THE stand-off between Medi-Clinic and The Namibian Association of Medical Aid Funds (Namaf) over hospital tariffs has been resolved after protracted negotiations.

In a press statement yesterday, Medi-Clinic said: “Following successful negotiations, Medi-Clinic and Namaf have agreed on tariff policies that will apply to members of private medical aid funds. “In terms of the agreement, the medical aid funds have reinstated the guaranteed-payment system whereby Medi-Clinic will be reimbursed directly for claims against services provided to fund members.”In return, Medi-Clinic will no longer require 18 per cent upfront deposits from medical aid fund members and will charge according to the Namaf tariff structure.As part of the agreement, Namaf and Medi-Clinic agreed to commission independent consultants to assess the true cost neutrality of the pricing model and will jointly announce the outcome of the assessment.Namaf announced two weeks ago that it was cancelling its guaranteed-payment agreement with Medi-Clinic with effect from September 12 and called on members to rather use other private hospitals.This was done after Namaf said hospital tariffs were too high, and demanded that the private hospitals lower their tariffs by 18 per cent.The other private hospitals complied, but the Medi-Clinic Group refused to budge.It decided to charge patients the 18 per cent excess in the form of an upfront deposit.At that time, Namaf said members who preferred using Medi-Clinic would have to pay the deposit and also settle their hospital bill before claiming a refund.The week-long cancellation is understood to have affected operations at the hospital chain, as patients cancelled procedures because they could not afford to pay the bills.”In terms of the agreement, the medical aid funds have reinstated the guaranteed-payment system whereby Medi-Clinic will be reimbursed directly for claims against services provided to fund members.” In return, Medi-Clinic will no longer require 18 per cent upfront deposits from medical aid fund members and will charge according to the Namaf tariff structure.As part of the agreement, Namaf and Medi-Clinic agreed to commission independent consultants to assess the true cost neutrality of the pricing model and will jointly announce the outcome of the assessment.Namaf announced two weeks ago that it was cancelling its guaranteed-payment agreement with Medi-Clinic with effect from September 12 and called on members to rather use other private hospitals.This was done after Namaf said hospital tariffs were too high, and demanded that the private hospitals lower their tariffs by 18 per cent.The other private hospitals complied, but the Medi-Clinic Group refused to budge.It decided to charge patients the 18 per cent excess in the form of an upfront deposit.At that time, Namaf said members who preferred using Medi-Clinic would have to pay the deposit and also settle their hospital bill before claiming a refund.The week-long cancellation is understood to have affected operations at the hospital chain, as patients cancelled procedures because they could not afford to pay the bills.