Can You Afford An Ambulance?
When a loved one is straddling the line between life and death, you won’t hesitate to call an ambulance. But once they’ve been stabilised and delivered to the nearest hospital, you’ll be faced with the bill.
Personal finance website JustMoney.co.za, which aims to provide up-to-the minute, user-friendly advice on money matters, investigated how much an ambulance trip costs in South Africa, whether you can refuse to enter an ambulance, and who pays the bill if you’re unconscious when an ambulance is called.
Says Shafeeka Anthony, JustMoney Marketing Manager, “The Covid-19 pandemic has made us far more aware of the possibility of needing health services in a hurry. Having proper medical cover in place is essential, and it’s well worthwhile educating yourself on the schemes available, and heeding advice to ensure you have the right cover for your needs.”
According to Denver Ramnarain, director of ambulance services organisation Quick Response Services, the National Reference Price List for Ambulance Services (NRPLAS), released in January 2009, is used as a price guide. This does not refer specifically to ambulance prices, but to the services provided en route. Industry organisations have implemented an increase of 5% year-on-year to these prices, to account for inflation.
According to the Road Accident Fund Medical Tariff document, these are the fees you’re likely to pay for an ambulance in 2021.
| Advanced Life support | Intermediate Life Support | Basic Life Support | ||
| Metropolitan Area | Up to 45 Minutes | – | R2,434.53 | R1,902.99 |
| Up to 60 Minutes | R4,281.29 | – | R2,535.09 | |
| Every 15 Minutes thereafter | R1,070.32 | R811.56 | R634.33 | |
| Long Distance | Per km (>100km) with patient | R53.41 | R40.65 | R31.65 |
| Per km (<100km) | R10.52 | R10.52 | R11.11 |
This price list distinguishes between three kinds of emergency life support: basic, intermediate, and advanced. All three are interventions used to stabilise patients until they reach a hospital. Depending on the state of the patient, emergency personnel will perform the necessary life support to ensure their safety.
The main difference between basic and advanced life support is that the former does not include invasive treatments – in other words, a patient’s skin will not be pierced, such as with a needle or a scalpel, if they receive basic life support.
The patient will be billed according to the category their life support falls under. For example, if your lung collapses in an ambulance and emergency personnel need to puncture your chest to re-inflate it, this will be considered advanced life support because your skin had to be pierced.
All emergency medical service providers invoice the medical scheme if the patient is insured, or the patient directly if they do not have medical insurance cover, says Shalen Ramduth, director of operations at Netcare 911.
Paying the bills
In South Africa, medical aid providers have partnered with specific private emergency companies, outsourcing them to clients to call in an emergency. If patients call a different company, insurers only pay 40-60% of the account.
If you were unconscious when the call was made, the insurer will assume that someone else called and the full account will be covered. But this must be motivated by the transporting ambulance service, who will need to advise why the client didn’t follow the correct procedure.
Ramnarain points out that ambulances are not financial institutions and, as such, they cannot offer patients credit. Patients often say they either can’t pay anything, or they didn’t call the service, and so refuse to pay, says Ramnarain.
Refusing service
A patient can refuse care from anyone, regardless of whether they can afford it or not. If a person refuses transport due to finances, it’s their choice. But the onus remains on the treating medic to make sure that the person is not in a life-threatening situation.
Ramduth says that all emergency medical service providers should assist with life-threatening cases, even where patients cannot pay for the treatment received.
If they decide to wait longer than necessary and not transport a person with life-threatening injuries, this could be considered neglect, which can be reported to the Health Professionals Council of South Africa (HPCSA).
“However, this is hard to prove as the person may decide that they don’t want treatment and may not disclose that it is due to cost. Or the medic may be acting in the best interest of the patient and they could still die,” says Ramnarain.
State services
According to the Western Cape Government’s website, no one will be refused emergency medical services based on their ability to pay for the service.
It states that if you’re a member of a specific medical aid, you’ll be charged uniform patient fee rates agreed with the medical aids. And if you’re not, you’ll be assessed according to your income, and charged accordingly.
Ramduth points out that South Africans are protected under the National Patients’ Rights Charter, which means that they have the right to medical assistance.
“If an uninsured patient is not experiencing a life-threatening emergency, they have access to the provincial emergency services which will render stabilisation and transportation to a hospital if required, at no cost to the patient,” says Ramduth.
Says Anthony, “If you experience problems with repayments of medical bills, discuss your situation with your creditors. People will be more understanding if they know the situation and you can work out a repayment plan together.”
If debt is giving you sleepless nights, debt consolidation could be a consideration. This system focuses largely on combining your monthly debt payments and allowing you to repay the debt in a manageable and financially safe manner.
For more visit: www.justmoney.co.za