ANAESTHESIA BILLING

Patients will receive an account from Dr Steyl for their anaesthetic, which is separate from all other accounts. Patients
may also receive other accounts from the hospital, the surgeon, radiologists, physiotherapists, and pharmacies.

Please take careful note of the following information regarding how the bill for your anaesthesia is calculated. Your
account will be made up of four fees that are each assigned a value, and these values are then added together to
determine the final anaesthetic cost:

CONSULTATION FEES

There will always be a pre-operative consultation fee. This is for the
anaesthesiologist to review your medical history, results and physical
examination. This information is used to make a risk assessment and to plan
for the most appropriate anaesthetic technique.

In some cases, there may be a fee for post-operative consultations, especially
if the patient is admitted to the high care unit or intensive care unit, or if the
patient received a regional anaesthetic that needs a follow-up consultation.

PROCEDURE FEES

A basic fee is calculated according to the anaesthetic difficulty of the
indicated surgical procedure.


There may be additional anaesthetic procedure fees, for example, if your
anaesthesiologist has to place a central line or arterial line for monitoring
during the surgery, or if your anaesthesiologist does a nerve block or epidural
injection for pain relief after your procedure. Some of these procedures are
done with ultrasound guidance to make them safer, and a fee may be
charged for the use of ultrasound during the anaesthetic procedure. Other
procedures performed by your anaesthesiologist may include placing a
nasogastric tube or setting up a patient-controlled analgesia (PCA) pump.

TIME-BASED ANAESTHETIC FEES

Your anaesthesiologist is with you throughout the procedure to care for you
while you are under anaesthesia, to monitor your vital signs and manage any
potential problems that may occur.

Depending on the duration of your procedure/operation, a time-based
anaesthetic fee is levied per 15 minutes (or part thereof) of your procedure.
There may be a time-based fee for goal-directed blood pressure control
during the procedure, especially for critical patients or during certain kinds of
surgery.

All the time modifiers are allocated specific unit values and each unit is then
given a Rand value.

It is not possible to predict accurately how long a procedure will take, and
this makes estimating the cost of an anaesthetic extremely difficult. Any
cost estimate is therefore based on the average time taken for a procedure.
If the procedure takes longer than the estimated time the cost will increase
according to the duration of the procedure.

ADDITIONAL FEES

There may be additional fees, depending on the anaesthetic risk and the
monitoring and positioning that is needed for the case. All the risk modifiers
are allocated specific unit values and each unit is then given a Rand value.

An emergency fee may be charged if your procedure was not booked
before the start of a list, or if it is booked as an emergency case. This is not
dependent on the time of day when the procedure takes place.

An emergency travel fee may need to be charged if the anaesthesiologist
made an unscheduled trip to the venue where the procedure takes place.

Some procedures are done in positions that make monitoring the patient
more difficult, and may therefore carry additional risk. An additional fee may
be charged when a patient is positioned for example in the lateral or prone
position.

Patients younger than one year, or older than 70 years of age have a higher
risk of anaesthetic complications. An additional fee may be charged based
on this risk.

Patients with a body mass index (BMI) greater than or equal to 35 kg/m²
have a higher risk of anaesthetic complications. An additional fee may be
charged based on this risk.

Surgical procedures around the head and neck carry additional risk because
the anaesthesiologist does not have easy access to the patient’s airway. An
additional fee may be charged based on this risk.

Some orthopaedic procedures (bone surgery) have additional fees
(modifiers) depending on the site of surgery.

Patients that have systemic illnesses causing functional impairment, or
patients that are admitted to intensive care or on a ventilator before surgery
have a higher risk of complications. An additional fee may be charged based
on this risk.

Additionally, please note that every anaesthetic account has to include 15% VAT as the government has legislated that
healthcare is a value-added item.

Further explanations of the codes on anaesthetic accounts can be obtained from
The Board of Health Funders: +27(0) 11 537 0200.

Dr Steyl uses a professional billing company (Medical Account Consultants) that will assist with sending patient
accounts to their medical aids to help with their claims. However, the patient remains responsible for payment of their
anaesthetic account to their anaesthesiologist. Interest and all legal fees that arise from any accounts that are not paid
in full within 60 days will also be for the patient’s account.

Contact Medical Account Consultants