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10 quick questions on designated service providers (DSPs)

All medical scheme members will, sooner or later come across the term Designated Service Provider (DSP). Knowing what it means can save you a lot of money.

What is a designated service provider (DSP)?

This can be a doctor, a pharmacist, a hospital or any other registered healthcare provider that is the first choice of your medical scheme.

Does every scheme have different DSPs?

Yes, they can, but there is usually some overlap, especially when it comes to bigger schemes. Every scheme and every option within a scheme can be different, but many of the larger schemes have networks of designated service providers, both in-hospital and out of hospital.

Do all schemes have DSPs?

No, they don’t. Some of the smaller schemes do not have DSPs, which means you can visit any registered healthcare provider. You will still be liable for co-payments, though.

What is the advantage of using DSPs?

What it comes down to is that when you use the DSP of your scheme, it is unlikely that you will have to make co-payments for the diagnosis, treatment and care of a prescribed minimum benefit.

Is there a limit to out-of-hospital treatments?

Yes. Two things you need to remember – firstly, a fair amount of out-of- hospital treatment is dependent on funds available in your Medical Savings Account (MSA). There may be other benefits on your option falling outside of the MSA. Secondly, people on hospital plans usually have to fund out-of-hospital treatment themselves.

Why is it cheaper for to use a DSP?

It is usually cheaper for you to use a DSP, as your fund negotiates tariffs on an annual basis with hospital chains, pharmacies and other service providers. They are in a much stronger bargaining position than you are as an individual. Nevertheless, you must remember that even healthcare providers who are not DSPs, are usually willing to negotiate tariffs.

What about non-DSP private doctors?

Many private doctors do not charge medical fund tariffs, and if there is a shortfall, you will be liable for the difference. Technically, if you are treated for a PMB by a DSP, you should be covered. If not, the difference is your problem.

Can my scheme force me to use a DSP?

No, they can’t, but you will be liable for the difference between the fund tariff and the actual bill.

What happens in an emergency?

If you are in an accident, and there is no DSP nearby, your scheme will have to pay in full for the costs of paying for treatment for a PMB condition, regardless of where you receive treatment. If possible, they may move you to a DSP facility.

What if there is no DSP near where I live or work?

If there really is no DSP nearby, your scheme will have to pay in full for the DSP that you do use for the treatment of a PMB condition. DSP facilities have to be accessible and available for your scheme to insist that you use them.

Are state facilities considered DSPs?

They can be, but you need to read the small print in your benefit schedule. On some of the low-cost hospital plans, the state hospitals are listed as the DSP for certain expensive conditions, such as cancer treatment.