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| Why are Designated Service Providers important?
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A Designated Service Provider (DSP) is a
healthcare provider (doctor, pharmacist, hospital, etc) that
is a medical scheme’s first choice when its members need
diagnosis, treatment or care for a PMB condition.
If you choose not to use the DSP selected by your scheme, you
may have to pay a portion of the bill as a co-payment. This could
either be a percentage co-payment or the difference between the
DSP’s tariff and that charged by the provider you went
to.
Medical schemes have to ensure that it is easy for beneficiaries
to get to the DSPs. If there is no DSP within reasonable distance
of your work or home, then you can visit any provider and the
scheme is obliged to pay.
When you suffer an emergency condition, or are involved in
an accident, you may go to
the nearest healthcare facility for treatment, even if it is
not a DSP. Your scheme will have to cover the costs.
Schemes also have to ensure that the DSPs of their choice can
deliver the services needed and without members having to wait
unreasonably long. Where a DSP is unable to accommodate or treat
a member, the medical scheme remains liable for all the costs
of treating the PMB condition at a non-DSP.
The State’s healthcare facilities can be, but are not
necessarily, DSPs. Before they can be listed as such, schemes
have to make sure that their beneficiaries can get to the facilities
and that the required treatment, medication and care are available
and accessible. |
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| Treatment at DSPs can be handled in two ways: |
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Schemes can insist that you go to a DSP
as soon as your condition is diagnosed, in which case they
cover the costs from the start. Treatment at a DSP will be
covered in full by the medical scheme under the PMB conditions
when delivered according to scheme protocols and formularies. |
| 2. |
If your benefit option allows for this,
you can be treated by the doctor of your choice. If you choose
to use a provider of your choice for these services, the scheme
may apply a co-payment, as registered in their rules. |
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