Doctors in private practice, who have already seen a decline in patient visits due to fears of Covid-19 transmission, now face a fresh challenge as medical schemes offer lower reimbursement rates for virtual consultations.

Two of SA’s leading medical scheme administrators, Discovery Health and Medscheme, confirmed on Tuesday that they are paying less for telemedicine consultations covered by their client schemes than they do for face-to-face interaction.

The move has upset SA’s biggest doctor organisation, the SA Medical Association (Sama), as its members have already seen their income knocked by a decline in visits to their practices. SA is currently in the middle of a three-week lockdown, which requires all but essential workers to stay home and only go out if they need essential household items, such as food or medicine, or need vital medical care.

The disease has been recorded in all nine provinces, and the tally as of Tuesday evening, stands at 1,749 cases and 13 deaths.

Discovery Health, which has 19 client schemes including Discovery Health Medical Scheme (DHMS), said it had set virtual consultation rates at 65% of those usually provided for face-to-face consultations with doctors and specialists. DHMS is SA’s biggest open medical scheme.

Medscheme is also paying less for virtual consultations than it does for face-to-face interactions, according to it executive director for healthcare management Lungi Nyathi. Medscheme’s biggest client is the Government Employees Medical Scheme (GEMS). She said the lower tariff for telemedicine is consistent with international best practice, and is being applied to all the schemes it administers.

Sama chair Angelique Coetzee said the organisation’s members are unhappy because medical schemes have not provided a rationale for the lower rate, or indicated a willingness to negotiate. “We are price takers,” she said.

Discovery Health CEO Ryan Noach said the lower rate applies to all disciplines, including GPs and specialists, because virtual consultations are shorter, have lower input costs, and do not require the use of consumables such as tongue depressors, swabs, and gloves. A virtual GP consultation is currently reimbursed at R310. 

“These rates are benchmarked against global tariff comparisons, particularly in the US, where virtual consults are well established. In most situations, virtual rates are set at approximately two-thirds of face-to-face, [consults]” he said.

“We recognise that [virtual consultations] are being used to substitute revenue for practitioners who are forced out of face-to-face practice during Covid-19 ... but must position the tariffs to ensure long-term sustainability way beyond our emergence from the Covid-19 lockdown and precautions,” said Noach.

Discovery Health is reviewing the rates for mental health practitioners and considering adjusting to the full rate, as virtual consultations are of a similar duration to those they do face to face. It said it has taken note of “numerous requests” to reconsider its rates. 

Said Noach: “Understanding the pressures presented by the lockdown and the wider Covid-19 situation, we have increased the rate for doctors consulting on Discovery’s DrConnect [online platform] to 75% of the in-room consultation rates.”  


Would you like to comment on this article or view other readers' comments?
Register (it’s quick and free) or sign in now.

Speech Bubbles

Please read our Comment Policy before commenting.