Billing at 100%, 200% or 300% - A Doctor’s Guide to Medical Aid Rates in South Africa

Introduction If you’ve ever felt stuck charging the same rate as the medical aid’s “contracted in” fee, here’s some good news: you have more flexibility than you may have thought. Many doctors assume that once they’re contracted with a scheme, their hands are tied. In reality, you can bill at 100%, 200% or even 300%, as long as you’re clear about who pays the difference. Let’s take a closer look at how this works and why it might matter to you.

Is "Contracted In" Really Written in Stone?

“Contracted in” usually means you’ve agreed on a rate with the medical aid, and they’ll pay you directly at that rate. But being contracted in doesn’t automatically lock you into 100%. If you need to charge more perhaps because of rising practice costs or the extra time you spend with patients, you can. The patient covers whatever their medical aid doesn’t.

This can be a game-changer if you’ve been reluctant to adjust your rates, fearing you’d breach your contract. Many doctors discover they can bill at 200% or 300%, recouping costs while still maintaining a workable arrangement with the scheme.

What Does 100%, 200% or 300% Actually Mean?

When a medical aid says it covers 100% of its “scheme rate,” that might be, for example, R400 for a consultation. At 200% they’ll pay up to R800, and at 300% up to R1,200, and so on. If your fee is higher than the scheme’s coverage, the remainder is billed to the patient.

Why Doctors Choose to Charge Above the Base Rate

• Increased Practice Costs

  Equipment, overheads, staff salaries, and cutting-edge tech aren’t standing still. If your costs have climbed, it might be necessary to increase your rates to keep your practice sustainable;

• Expertise & Patient Care

  You might spend more time with each patient or offer services that go beyond a standard consultation or you are a specialist in your field. Charging a higher rate can reflect that added value;

  • Maintaining Quality

    Running a modern practice, complete with digital records, telehealth options, or advanced diagnostics, takes investment. Sometimes billing at 200% or 300% keeps that level of care feasible.

  
  

  Communicating Clearly with Patients

  If you plan to charge above the typical scheme rate, communication is everything.

  Patients often accept higher fees if they see the value. A note pinned at the reception desk helps protect everyone from surprise bills later on.

  
  

  How this May Affect Your Cashflow/Bottom Line

  • Revenue Boost: Billing higher than the standard rate can boost your revenue;

  • Faster Payouts: If you’re contracted in, medical aids pay you directly, which can streamline your collections;

  • Potential for Gaps: If you charge above the standard medical aid rate, you may have to chase the patient for the difference;

  • Budgeting & Reserves: Make sure you have a system to stay on top of who owes what and when and to track which claims are fully covered, partially covered, or unpaid. Set aside reserves for delayed payments.

Conclusion

“Contracted in” does not mean being stuck at 100% forever. If your practice needs a different rate to cover growing expenses or reflect higher levels of care, it’s worth exploring the option of 200% or 300% billing. Just be sure to communicate openly with patients, and keep your records clear and organised.

Need more clarity on how to implement these rates or how to handle the billing process? At SOLVE, we specialise in helping medical professionals streamline their finances, manage cash flow, and stay compliant. Email sandi@solveservices.co.za or Book a 30-minute Discovery Call  to explore how we can support your practice, no matter which rate you choose to charge.

BLOG 2025/02