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Hit by unpaid medical bills

Feb 23 2015 17:17

A Fin24 user was shocked when debt collectors contacted her regarding an outstanding medical bill she thought her medical aid had paid years before. She writes:

I received a call from a man who advised me that he is collecting debt for a doctor who treated my child a few years ago.

The doctor was the anaesthetist to a doctor, who performed three operations on our daughter.

I requested the debt collector to send me the details so that I could check what happened.

I can also remember a woman calling me a few months before the man, stating that an amount of R3 000 was due for this same doctor from 2009 a few years before. At that stage I advised the woman that, as far as I am aware, all amounts was paid by the medical aid – nothing was rejected.

In fact, we had to go through extreme processes - like motivational letters from the doctor - to obtain authorisation numbers from the medical aid for each operation done on our daughter. I never heard from the woman again.

When the debt collector called me for a second time, I asked him why am I only being advised about this situation after a few years?

He replied that a woman who worked in the accounts department for the doctor, did not do her job and no accounts were settled.

I also pointed out that the medical aid authorisation numbers were supplied. Why was this account not sent to the medical aid?

My concerns are that our medical aid covered each operation in its entirety. I am now unemployed and have no means to pay this outstanding amount.

Please could you assist me with advice on how to deal with this going forward?

READ: Medical specialists charge way too much - report

Brigs Venter, associate: insurance/general litigation at Herold Gie Attorneys, responds:

In terms of your contractual agreement with your medical aid scheme, you are bound by the rules of the medical aid scheme. These rules will most likely require you to submit all claims within a certain period of time, and place an onus on you to inform your medical aid of all the accounts you wish to claim for.

You, therefore, have limited right of recourse against the medical scheme itself.

However, since the account of the medical specialist was issued "a few years ago", you may have a defence against the debt collector's claim by relying on the Prescription Act.

READ: Medical savings account fact sheet

What is prescription?

Prescription is when the obligation to pay money or a debt is extinguished after the passing of a certain period of time.

Calculating when a debt has prescribed

There are various terms of prescription in our law, the most common of which is the three year prescription period.

In order to calculate when the prescription period will begin to run, one must look at when the debt became "due".

In the case of Farocean Marine v Minister of Trade and Industry (2006) the Supreme Court of Appeal held that a money debt is "due" when there is a liquidated monetary obligation presently claimable by the creditor for which an action could presently be brought against the debtor.

Importantly, though, Section 12(3) of the act imposes a duty of care on the creditor to exercise reasonable care to obtain knowledge of the identity of the debtor and the facts form which the debt arises.

In the case of Harold Gunase v Ramesh Anirudh (2011), the Supreme Court of Appeal reiterated this principle and stated that a creditor is not allowed to postpone the commencement of the running of prescription by his failure to take necessary steps.  

Therefore, the impact of s12(1) read in conjunction with s12(3) is that prescription starts to run as soon as the creditor has or ought to have knowledge of the identity of the debtor and the facts from which the debt arises.  

Applying these principles to the present set of facts, it would appear that the medical specialist failed to exercise reasonable care as required by s12(3). If he had, he would have become aware that, due to an error in his own accounting practice, the invoice was never sent to the reader.

Therefore, if it has been more than three years from the date on which the reader received the medical treatment, then the claim by the medical specialist would have prescribed and the you are under no obligation to settle it.

ALSO READ: How to save money on your medical expenses

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court  |  money  |  money clinic  |  debt
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