The failure to find a compromise between the Botswana Medical Aid Society (BOMAID) and some of the private medical aid service providers regarding pricing has led to a temporary “ceasefire”, which involves concurrent utilisation of both the newly introduced “balance billing” method and the more conventional “Capitation model”.
BOMAID Business Development Manager, Thulaganyo Molebatsi, however, stated that nothing had been concluded as yet and that, for now, “Members are allowed to go to all contracted service providers regardless of whether the provider uses balanced billing or capitation.”
In a letter addressed to “All BOMAID Members,” medical doctors and specialists have been classified into groups one and two; Balance Billing and Capitation Model, respectively.
It is stated in the letter that “will receive a BOMAID 2012 tariff list relevant to their practices clearly stating the maximum tariff limits and the maximum ‘out of pocket’ contribution by the member as stipulated in the Rules of the Society”.
For those in group 2, it was requested that they submit to the Society “their exact level of charges per individual practice so that our membership can be informed accordingly”.
According to the letter, it is indicated that the issue of other stakeholders, the Botswana Dental Association (BODEA) is still with the Botswana Competition Authority. The Optometrists are said to be, in conjunction with BOMAID, developing a mode in which members will not be making any “out of pocket payments” on their trips to the optician.
The letter further assures members that “negotiations with hospitals and hospital groups in the region have been concluded”.
Molebatsi, however, reiterated that despite these conditions, BOMAID will only be paying the service providers as per their prescribed tariffs and it is up to the members to decide which service providers they go to.
As a way of guiding their members, Molebatsi also indicated that all service providers using balance billing were expected to provide their charges and it would be “the prerogative for each service provider to manage his/her business in the manner in which they deem fit”.
Molebatsi also stated that despite this, negotiations between BOMAID and all the relevant stake holders were still ongoing.