Part of transparent and open medical care is an up-front discussion of costs and expected fees.

For consultations I work close to the old 'medical rate' whenever possible because I do many rooms-based procedures, and these amount to a figure I consider fair return for my services. For prolonged consultations or complicated issues, i.e. longer than 20 minutes I will apply code 0191. Most medical aids do not remunerate code 0191.

For operations I base my fees on 'private rates' which may be significantly more than medical aids pay.  It all depends on what medical policy you have.  Some pay my fees in full, others as little as one third.

The days of the 'medical aid rate' are over.  At present it is against the law for anyone to recommend or publish fees over and above what is known as the National Reference Price List, based on the old 'medical aid' rate, and used only by the Department of Health as a standard.

The old 'medical aid rate' was a negotiated settlement where doctors cut their fees by 50% in return for guaranteed numbers of patients with unlimited benefits.  Those days have long since vanished, and the original terms of this contract have been forgotten.

Medical costs, especially of running a practice, have soared.  Doctors have been asked to submit cost studies to the government.  These have been ignored because the results showed the NRPL seriously undercuts the value of doctors' services.

I welcome frank and open discussion about fees, and will always make allowances for those in financial difficulty.