The Council for Medical Schemes (CMS) is contesting the manner in which the South African Medical Association (Sama) published regulations on how specialist doctors bill patients.
The two parties are before the Competition Tribunal, to argue this matter of alleged price-fixing by specialists.
The outcome of the case is important as it could influence how medical schemes reimburse members.
CMS's legal advisor Alicia Schoeman explains that several medical associations are publishing and using codes not listed on the National Health Reference Price List.
This mean that medical practitioners bill patients under codes that are not covered by some medical schemes, leaving consumers to foot the bill out of pocket.
It's not so much their relationship with each other that we are concerned with. But each of them are practicing price-fixing in the sense that they are using codes that are not on the National Health Reference Price List (NHRPL).— Alicia Schoeman, Legal Advisor for Council for Medical Schemes
Sama Chairperson Dr Mzukisi Grootboom was scheduled to speak but was not available for comment.
Take a listen to Alicia Schoeman explain: