What are Designated Service Providers?
Hospitals, clinics, pharmacies, nurses, doctors, specialists – they are all designated service providers. And they play an important role in helping you attend to your health. They provide you with their skills and knowledge.
Sometimes your medical scheme will stipulate that you make use of the services of certain service providers. They do this so as to reduce costs. If you don’t want to make use of these designated service providers, you will be required to make co-payments.
Designated Service Providers (DSPs) are NOT automatically State Hospitals
Medical aid schemes have the freedom to contract with designated service providers of their choice. Some people just assume that a designated service provider is a state hospital but this isn’t so. Some confusion arose about this in the past. Schemes have the right to designate the state hospital as their DSP. But then they should ensure that the provider is indeed available to accommodate services to their members.
Members shouldn’t have to put in a day’s leave to stand in a queue at a public hospital to get medications. When approving scheme rules,the Registrar requires schemes to show that they have conducted an assessment of their DSPs and that they are capable of delivering adequate, timeous and available services. The bottom line is that medical schemes are able to have arrangements with both the public and the private sectors, and these DSPs must deliver.
Proper Care, the Best Prices and Decent Medical Care Faclities
The reason for DSPs is to ensure members get proper care at decent places. These DSPs offer some form of guarantee of readily available services for members. Soliciting the services of a DSP puts schemes ahead because it shows that they’re planning for their members and have selected DSPs who have the skills and capacity to render the required services.
The scheme is also able to determine the financial side of things surrounding the care provided to members. DSPs become a preferred service provider for members because they know that their claims will be settled and they will enjoy discounted rates.
When you make use of the services of a designated service provider or DSP as it is also known, claims, including PMBs or Prescribed Minimum Benefits, are paid in full. The benefit of this is that you won’t have to make any out-of-pocket payments with the use of these service providers.
However, in some instances you won’t have to pay deductibles or co-payments. The Scheme will pay the Prescribed Minimum Benefit claims if you have involuntarily obtained the services from a provider other than a DSP. They will pay in full for instance:
- if the particular service wasn’t available from a specific DSP
- the service couldn’t be provided without unreasonable delay
- the scheme might also pay if there is an emergency
- there was no designated service provider found close enough to where you live or work
Specialists for instance, who have agreed to provide services according to a certain set of rules are DSP. They are specific providers of health care services and the scheme pays these service providers directly.
No DSPs? The Medical Scheme must Pay Up
If the scheme you’re with doesn’t list DSPs in its rules, then make sure you don’t pay any co-payment as the rule is that the medical scheme must pay in full for the cost of PMBs.