Terms & Conditions of the Practice
By signing this I declare that I have read the Practice's terms and conditions (Available on the Practice website) and that I have understood the information therein.
Please ensure that you pay specific attention to the following terms and conditions of this agreement. They require you to acknowledge the fact and limit the liability Dr T Wong and Dr S Shen INC.
By signing this form, you acknowledge that you have understood and agree to the following:
a) Where the patient is not the main member of their medical aid, you acknowledge that the main member has given permission for consultation and treatments to be claimed from your medical aid.
b) Some medical aids require pre-authorisation and/or motivation prior to treatment. Pre-authorisation or scheme approval is, according to the medical aid, no guarantee of payment. You are responsible for obtaining pre-authorizations for consultation and treatments.
c) It remains your responsibility to familiarize yourself with the benefits and terms and conditions associated with your chosen medical cover.
d) The person whose signature appears on this form, remains responsible for the payments of any shortfalls in medical aid cover. You will be notified of any amounts owing to the practice by the practice manager and will be required to settle outstanding amounts within 7 days. Further consultation and treatments may be placed on hold in the event of non-payment.
e) Although every attempt is made to resolve medical aid queries, it remains your responsibility, and not the practice, to contact and follow-up on unresolved queries or non-payments.
f) If your medical aid is depleted, your account will be charged according to cash rates on the day of your appointment.
g) Should you not inform the practice that your medical aid is depleted, or that you wish to convert to cash/EFT payments, you will still be charged at medical aid rates where the practice has already submitted claims on your behalf.
h) In the event of special motivations or applications for PMB’S (Prescribed Minimum Benefits) for funding by your medical aid, the practice cannot guarantee approval or payment by your medical aid. You remain responsible for all payments until approval for funding by your medical aid is received. You are also responsible to ensure that PMB claims are correctly processed by your medical aid.
i) Medical aid rates are determined by the individual medical aids. It is your responsibility to familiarise yourself with your medical aid’s rates.
j) Dr T Wong and Dr S Shen INC cannot be held responsible for any errors or incorrect use of funds made by your medical aid.
k) Patients are encouraged to approach the practice immediately if they experience problems with the payment of their account.
l) Accounts are handed over for legal debt recovery after 90 days. Any costs associated with such actions will be incurred towards the person responsible for the account. This may result in having a bad credit record.
m) If you feel that your medical aid scheme should have paid your account in full, you can lay a complaint at the Council for Medical Schemes by emailing them at complaints@medicalschemes
通过签署本表格，您确认已理解并同意以下内容：
a) 如果患者不是其医疗保险的主会员，您确认主会员已授权本次看诊和治疗，并同意通过您的医疗保险进行索赔。
b) 某些医疗保险在治疗前可能需要预先申请授权同意根据医疗保险规定，预先授权同意并不保证支付。您需自行确保为看诊和治疗获取所需的授权同意。
c) 您需要自行了解所选择医疗保险的福利范围及相关条款与条件。
d) 本表格签字人需要对不包含在医疗保险内的部分的付款负责。诊所经理会通知您任何应付金额，您需在7天内予以结清。如未按时付款，后续的看诊和治疗可能会被暂缓。
e) 尽管诊所会尽力协助您处理医疗保险相关问题，但未解决的查询或未付款事宜的最终责任仍由您自行承担。
f) 如您的医疗保险额度已用尽，预约当天您的账单将按现金费率结算。
g) 如您未告知診所醫療保險額度已用盡，或未說明希望改為刷卡支付/EFT支付，即便診所已代您提交索賠，仍將按醫療保險費率收取費用。
h) 在涉及特殊动机或申请医疗保险规定最低福利（PMB，Prescribed Minimum Benefits）以获得医疗保险资金支持的情况下，诊所无法保证医疗保险会审批通过该申请。在醫療保險批准前，所有相關費用均由您自行承擔；同時，您亦有責任確保 PMB 索賠由醫療保險正確處理。
i) 醫療保險費率由各保險機構自行決定，您有責任熟悉並了解所選醫療保險的費率。
j) 对医疗保险的任何错误或资金使用不当，Dr T Wong and Dr S Shen INC 不承担任何责任。
k) 如在帳單支付過程中遇到任何問題，建議您立即聯絡診所。
l) 逾期90天未结清的账单将移交法律追缴处理，相关费用由账单责任人承担，可能影响您的信用记录。
m) 如您认为医疗保险应已全额支付您的账单，您可向医疗保险理事会提出申诉（Council for Medical Schemes）提出投诉，电子邮箱：complaints@medicalschemes。