-
The account is rendered completely separate from those of the Hospital/Casualty, the
anaesthetist and
any other medical accounts.
-
I
agree to
pay the
fees charged by Dr CND McIntosh. These fees are generally in accordance
with
guidelines
established by the Health Professions Council of South Africa (2005). In most
instances this
has
resulted in fees being higher than the guidelines of the Health Professions Council
(2009).
Most
Medical Aid benefits are likely to contribute only a small portion of the fees
charged.
-
I
understand that I
am personally responsible for payment of the account and that it is my responsibility to
claim
my refund
from my Medical Aid. I understand that NO ACCOUNT WILL BE SUBMITTED TO MY MEDICAL AID
for
consultations.
We will submit your account for theatre procedures, but you will still be liable for any
short
payments
from your Medical Aid.
-
If I
anticipate
problems in meeting my financial obligations to the practice, I will make arrangements
with the
Financial Controller that are mutually acceptable.
-
I am
aware
that
there may be practitioners whose fees are lower than those rendered by this practice.
-
As
stipulated by the Health Professions Council of South Africa, interest may be charged on
accounts that
have not been settled within 60 days from the date of treatment.
-
I
also
undertake to
pay all legal costs on the attorney and own client scale as well as tracing costs and
charges as
stipulated in the Debt Collectors Act 114 of 1998 relating to the recovery of fees
outstanding
on my
account in respect of professional services rendered.
-
I
hereby
choose the
address below or the address printed on the Hospital admission form as my DOMICULIUM
CITANDI ET
EXCUTANDI for all purposes under this agreement and that any notice sent to this address
will be
deemed
to have been received on the third business day after the posting of such notice.
-
I
further
agree that
any notice received by me by any means and at any address will be valid for all legal
purposes
notwithstanding that it was not sent by registered post of my DOMICULIUM CITANDI ET
EXECUTANDI.
-
I
agree that
should
I wish to change my DOMICILIUM CITANDI ET EXECUTANDI I will give one week’s prior
written notice of such
change to
become
effective.
-
I
agree that in event of me not paying my account within 90 days I can be traced and/or my
name
can be
placed with a credit bureau.
-
In the
event
of any
dispute that arises between the treating doctor and the patient, the patient agrees to
submit
their
dispute for mediation prior to initiating any litigation regarding such dispute.