How payment and medical aid work here

Physiotherapy is a claimable benefit on most South African medical aid plans. It usually comes out of a day-to-day or medical savings allocation rather than from hospital benefits, so how much you get back depends on your plan and on how much of that allocation you have already used this year.

Our rates are medical aid linked

The practice charges at medical aid linked rates, which means our fees are set against the scheme tariff rather than above it. That keeps the gap between what we charge and what your scheme pays as small as possible. Please confirm your available benefits with your provider before treatment, so there are no surprises.

We can submit the claim for you

We are able to submit claims to your medical aid on your behalf. It is worth being clear about what that does and does not mean: submitting the claim is a service we provide, but the patient remains ultimately responsible for the full payment of the account. If your scheme pays short, declines, or has exhausted your benefit, the balance is yours to settle.

What you need in order to claim

Every invoice from this practice carries the items a scheme requires:

The practice name, practice number, and the treating practitioner's HPCSA registration number
Your member number and the dependant code of the person treated
The date of service and the procedure codes for what was done
An ICD-10 diagnostic code

When a claim is rejected it is almost always because of a missing dependant code or an ICD-10 mismatch, rather than because physiotherapy is not covered. Send the rejection through and it can usually be resolved by reissuing the invoice.

Do I need a referral?

Not in order to be treated. Physiotherapists in South Africa are first-contact practitioners, so you can book directly. Some plans do require a GP or specialist referral before they will reimburse, so if reimbursement matters to you, it is worth a quick call to your scheme first.

Post-surgical and PMB cases

Where physiotherapy forms part of the treatment for a condition on the Prescribed Minimum Benefits list, or follows an authorised surgical procedure, it is often funded differently from ordinary day-to-day physiotherapy and may not draw on your savings allocation. Rehabilitation after a procedure such as an ACL reconstruction usually falls into this group. If you are coming to us after surgery, say so when you book so the authorisation can be checked before your first appointment.

No medical aid?

You are welcome either way, and the fee is the same. Tell us when you book and you will get an honest view of how many sessions the problem is likely to need, so you can plan the cost. In many cases a thorough assessment and a well-written home programme does most of the work, with fewer appointments than people expect.

Cancellations

We ask for at least 24 hours' notice to cancel or move an appointment. A no-show or a late cancellation is charged at the full rate, because that time was held exclusively for you. Accounts not settled within 30 days may be handed to a collection agency, with the additional costs for the patient's account.

Not sure where you stand? Call 076 174 9656 before you book and we will talk you through what your plan is likely to cover.

Three items for Luke to supply before this page goes live. Everything above is taken from the practice's own published Terms and is accurate as it stands. These three are not yet known and have deliberately been left out rather than guessed: the BHF practice number to publish, the current consultation fee (new assessment and follow-up), and whether any schemes are billed directly as opposed to claim-submitted. Add a sentence naming the schemes most of your patients are on, and this becomes one of the strongest pages on the site for converting search traffic.

Medical Aid & Insurance