SOS essentials

The N17 from Leandra to Ermelo reached the top 20 most dangerous road in South Africa.

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The Bulletin Newspaper

The Bulletin has reported on a number of accidents over the past few months. The N17 from Leandra to Ermelo reached the top 20 most dangerous road in South Africa. The R546 Evander to Embalenhle road produces its fair share of accidents. A number of them fatal.
All the photos posted shows various ambulance services at the scene of the accidents.
So which ambulance to use?
It is simple! The choice is yours!
There was an interesting case that served before the Council for Medical Schemes and a class judgement was made on December 22, 2017.
A number of medical aid schemes appointed Netcare 911 Prefered Service Provider. It appears from the court application lodged by Mr Oliver Wright, Chief Executive Officer of the South African Private Ambulance and Emergency Services Association (“SAPAESA”) that there had been serious irregularities with these appointments. It also seems that medical schemes were refusing claims by other Emergancy Services (EMS) and even referred them to Netcare 911. Oliver alleged that the medical schemes listed in the complaint were acting unlawfully and contravening the Act in the manner in which they dealt with claims submitted by members of SAPAESA.
Oliver alleged that the Respondents (the medical aids contracting netcare 911) were supposedly enabling Netcare 911 to act as an administrator on their behalf notwithstanding the fact that it is not an accredited administrator in terms of the Act and Regulations. He further alleged that Netcare 911 was allegedly receiving funds through a capitation agreement entered into with each of the respective Respondents whereupon it performs claim administration on their behalf. Netcare 911 allegedly accepts, clinically adjudicates and pays out claims for Emergency Medical Services (‘EMS’) rendered by other third party private ambulance service providers.
Oliver also raised the issue of Netcare 911 being pitted as a Designated Service Provider who not only renders emergency medical and evacuation services but also receives, assesses and effects payment of EMS claims to SAPAESA members on behalf of the Respondents.
The Council ruled that contracts with Netcare 911 is essentially null and void as some of the stipulations within the contract is not in accordance with the law and therefore the whole contract is not correct.
SUMMARY OF THE FINDINGS.
The Registrar finds that:
(a) The Respondents have enabled Netcare 911 to perform functions which in terms of the Medical Schemes Act and Regulations, it is not entitled and empowered to perform.
(b) The role of a DSP as defined in Regulation 7, does not countenance validation, processing and payment of claims. If Netcare 911 is an appointed DSP, it cannot usurp this function.
(c) A person or entity not accredited by Council as a managed health care organisation cannot enter into a valid capitation agreement.
(d) The Respondents must not continue to allow Netcare 911 to perform functions which require accreditation, for which it has not been duly accredited by Council.
(e) The Respondents have no legal basis on which to decline acceptance of claims submitted by third party EMS providers and/or members of SAPAESA.
(f) The Discovery Health (Pty) Ltd (“DH”) obo Bankmed contract with Netcare 911 may be in contravention of rule 23.4 and 20.8 of Bankmed registered rules in that DH signed this contract on behalf of Bankmed without authorisation by the Board.
The Council has given the respondents leave to appeal.
It would appear from this case and ruling that some Medical schemes were forcing emergency services to work through Netcare 911 as administrator, adjudicator and paymaster for claims submitted to them.
This now seems unlawful.
This is a class ruling that is applicable to every EMS.
The Council ruling changes the landscape for Emergency Medical Services and hopefully the beneficiaries will be you, the Patient.
Emergency Medical Services in Govan Mbeki Minicipality
Langamed Services South – Tel no: 0730999929
ER24 – Tel no: 084124
Provincial EMS – Tel no: 10177 of 112 from your Cellphone.

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