MEDICAL AIDS

JC Physiotherapy can bill directly to medical aids, if circumstances allow (where possible – medical savings balance can be checked). If this is not possible, you will be expected to make payment up front, and Jade can email your invoice to the medical aid to claim back the funds, on your behalf.

Rates are as follows:

First consulation: R830

Follow ups: R740

Home visits: R1200

Which Medical Aid do you use?

Discovery

Physiotherapy is only covered on plans with a Medical Savings Account and is not limited to a certain amount of sessions. It will be funded as long as you have funds available in the savings up to 100% of the Discovery Health Rate.
By using your medical aid membership number, Jade will be able to tell you whether you have sufficient funds for direct billing to Discovery.
If there are not sufficient funds, payment can be made upfront, and Jade can email your invoice to you, as well as to Discovery on your behalf.
The Sports Injury Benefit is only available on the Classic Smart Plan. You must visit your Smart Network GP to activate the Sports Injury Benefit. Once the benefit is activated, payment will be made from this benefit if the cause code and ICD-10 (diagnosis) code on the claim reflects a sports-related injury. You will be expected to make a co-payment of only R135 per treatment, and will be entitled to 4 treatment sessions.

Momentum

Out-of-hospital physiotherapy services can be covered under the day-to-day benefits or medical savings account, depending on the plan. For example, the HealthSaver+ option can supplement out-of-pocket expenses for physiotherapy.
The Evolve Option: 2 Physiotherapist consultations are available per year per beneficiary, up to a limit of R1 120 per year, subject to authorisation. For this, payment would be made upfront, and Jade will then email the invoice to Momentum to claim back on your behalf. The invoice will include this authorisation code. Unfortunately, this benefit is not available to people under the Incentive Option.
Prescribed Minimum Benefits: These include specific conditions where physiotherapy may be covered as part of ongoing treatment for chronic or rehabilitative conditions. Members need to ensure their physiotherapy is linked to PMB-eligible conditions. Members would pay upfront, and claim back.
Momentum encourages the use of their network providers and sometimes requires pre-authorisation for accessing benefits. Specific costs, co-payments, and limits vary across packages. To explore details tailored to your health needs, consulting Momentum directly or using their plan comparison tool is recommended.

Profmed

At present, Profmed patients are required to pay upfront and may claim back from their medical aids. Jade can email the invoice to the medical aid directly to assist with this.
Below is some information regarding physiotherapy and Profmed plans, however some plans may require pre-authorization for physiotherapy or be subject to network restrictions, so it’s important to confirm specific details with Profmed directly.
ProSelect and ProSelect Savvy: Suitable for young professionals, these plans offer unlimited in-hospital cover at network hospitals. Day-to-day benefits may be more limited.
ProActive Plus and ProActive Plus Savvy: These options provide a balance of hospital and day-to-day cover, including consultations and prescribed minimum benefits (PMBs).
ProSecure and ProSecure Plus: Designed for families and professionals, these plans provide broader hospital and out-of-hospital benefits, including physiotherapy and chronic care.
ProPinnacle: The most comprehensive option, ideal for those seeking extensive coverage, including private wards and advanced day-to-day benefits.

Medscheme Medical Aids

At present, Medscheme medical aid patients will pay up front and can be assisted with claiming back.
Medical aids that fall under Medscheme:

AECI Medical Aid Society
Barloworld Medical Scheme
Bonitas
Fedhealth
Government Employees Medical Scheme (GEMS)
Horizon Medical Scheme
MBMed Medical Aid Fund
Medshield
Parmed Medical Aid Scheme
SABC Medical Scheme
SAMWUMED
South African Police Service (POLMED)

CAMAF

Physiotherapy cover is subject to available savings. If you would prefer not to pay up front, please phone Camaf to confirm that there are sufficient funds for treatment. Should the claim be rejected, you will have 48 hours from the time of being notified regarding the rejection, to settle the account.
Alternatively, you can pay upfront and Jade will email Camaf the invoice to help claim back.
Certain Camaf membership options offer Prescribed Minimum Benefits. Please call Camaf to discuss your case and get a specific ICD10 code prior to treatment, if you would like this covered by medical aid.

Other

Patients expected to pay upfront. First consultations cost R830, follow up consultations cost R740. Home visits: R1200

If your medical aid scheme was not listed above, payment can be made upfront and Jade can email the invoice to your medical aid to help you claim back. Alternatively, she can email the invoice to you, for you to claim back.