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Ts and Cs and
Why does Bestmed use a Designated Service Provider (DSP) Network?
The main objective of a provider network is to offer sustainable high-quality healthcare services at Scheme tariffs with minimal or no co-payments, especially for treatment of diseases listed as Prescribed Minimum Benefits (PMBs) for which schemes are obliged to pay at cost.
What are the advantages of using a Specialist DSP Network provider for a PMB?
The specialist healthcare services (including medicines, dispensing fees etc.) will be charged at an agreed DSP rate, and members will incur minimal or no co-payments. These providers receive direct weekly payment from the Scheme and have access to a dedicated provider call centre facility at Bestmed.
Minimum co-payments mean that the provider may charge a co-payment, but the amount will be limited as per contract.
Are members forced to use DSPs?
Members have the choice to voluntarily use non-network providers. There is no penalty for a member who chooses to use providers outside of the Specialist DSP network. However, non-network providers may charge higher fees or co-payments which would be for the member’s own account.
There is no Specialist DSP in my immediate area, now what?
A member can contact our contact centre on 086 000 2376 or email us at email@example.com for assistance in locating the nearest Specialist DSP. If there are still non available, an out-of-network specialist provider will be authorised to render the healthcare services needed.
Why are some providers not in the Specialist DSP Network?
All providers are invited to form part of the network in accordance with inter alia the Medical Schemes Act, Health Professions Act and the Competition Act. Participation in the network is, however, at the provider’s discretion. Some providers may have chosen not to join in the network, their reasons may be either financial or related to practice policies.
What is the difference between a Preferred Provider (PP) and a DSP?
PP agreements may be written or verbal. The tariffs are agreed upon, but the providers are not included in the Scheme rules. The providers are only to be included in member communication material. A PP Network is binding, but less formal and no penalties may be levied for members going outside of the network. Designated Service Provider
DSP agreements are in written contract format. The contract describes the services as well as agreed upon tariffs which will be charged for services rendered, usually on a fee for service basis. If the provider does not charge the agreed upon tariffs, the money may be claimed back, or a fine be levied. The member may also be penalised for electing not to use the DSP. Bestmed has, however, not implemented a penalty on any of the existing networks. Furthermore, all DSP agreements must be verified by the Scheme, should the Council for Medical Schemes (CMS) require us to do so, and must be included in the Scheme Rules and member communication material. Using a non-DSP provider for PMBs may not be paid for in full.