People covered by medical schemes no longer have to pay for negative Covid-19 tests done in the private sector, as long as they are referred by a doctor or nurse
A Covid-19 test administered by Pathcare, Dis-Chem, or Ampath costs about R850 and it takes two to three days to get a result. A test through the state-owned National Health Laboratory Service is free to the patient, but the backlog for results is about a week.
Medical schemes interpreted this to mean that coverage applied only to confirmed cases. As a result, all medical schemes decided that positive Covid-19 tests would be paid for by the scheme but negative tests would be paid for from a member’s day-to-day account, or, if that account was exhausted, out of the member’s pocket.
On May 7, Netcare CEO Dr Richard Friedman issued a communique to staff in which he said patients must pay for their own tests before admission for surgery. If a patient is tested and found positive, said Friedman, the patient “will be required to self-isolate until such a time that a negative test result is obtained, provided that the delay does not negatively impact the clinical outcome. If admission is absolutely required, the patient will be admitted into the red zone at the appropriate level of care.”The South African Renal Society warned that many dialysis patients would not be able to afford the test.
Fedhealth said the scheme would not pay for negative tests unless “clinical reasoning” deems it appropriate that patients are tested, in which case the tests would be “funded according to scheme rules and benefit structures.”
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