An estimated 1,9 million road accident victims in South Africa are unable to get the medical treatment they need from private healthcare providers, despite undertakings from the Road Accident Fund (RAF) that their healthcare needs will be covered.
Valomate Medical Services, now makes it possible for patients to get private medical treatment related to an initial RAF claim, provided a section 17 (4) undertaking has been obtained via a court order. A Section 17 (4) undertaking commits the RAF to compensate the victim for future hospital and medical treatment after the costs are incurred and the treatment provided.
Backed by a partnership with specialist funder Taurus Capital, Valomate facilitates the necessary treatment with medical services providers, at no cost to the patient, and administers RAF claims on their behalf.
Section 17 (4) undertakings issued by the RAF allow for patients to be treated by private healthcare providers for the RAF’s account. But most go without because they are unable to pay for the treatment up front. Patients are only reimbursed by the RAF after the costs have been incurred and the treatment has been provided.
In addition, the Road Accident Fund allows for victims of road accidents to be treated at private hospitals in an emergency. The RAF processes these payments as Section 17(5) supplier claims. Valomate, working with emergency providers and following a rigorous vetting process, is able to manage claims against the fund on behalf of suppliers.
For their part, private healthcare providers are generally unwilling to take on these cases as they have had many claims rejected by the RAF. In addition, successful claims take between 180 and 210 working days to be settled. The process is complex and the RAF must verify the necessity and reasonableness of treatments it will cover, which adds more time to an already extended time frame for reimbursement.
Says Valomate CEO Bianca van Zyl, “One hospital group has accumulated RAF debt in excess of R300 million. Private healthcare providers simply cannot afford to carry this burden for extended periods.
“Valomate takes on the full risk of the claim from private medical services providers. We have a stringent pre-merit assessment, handle the specialist administration of RAF Section 17 (4) undertaking and Section 17(5) supplier claims, and guarantee payment to the medical services provider within 60 days.”
The patient categories Valomate pre-funds and administers are those where life-saving treatment is required immediately, for instance, they have been brought to a hospital by ambulance services; and where there are significant injuries that are not life-threatening, such as fractures or knee-replacement surgery. Coordinating various parties, such as specialists and facilities, is included in the service.
“Almost 200 000 Section 17 (4) undertakings are issued each year by the RAF, and only 4.5% of these undertakings are active. Even if a small percentage of these claimants need additional treatment, there are thousands more people who can be helped,” she adds.
Elad Smadja, Taurus Capital CEO, adds, “In addition to the funding we provide to Valomate, our partnership allows us to share commercial insight and expertise gained in our five years of providing specialist finance in South Africa. Our RAFPay offering provides immediate funding to road accident victims who have received an award by the courts, so we are familiar with RAF and are very comfortable in this space.”
In 2021, Valomate’s RAF patients spent an average of 12 days in hospital at an average cost of around R270 000 per patient. The most common injuries were multiple fractures.
Since its inception, Valomate has supported over 400 patients and its network comprises 26 contracted hospitals, 84 contracted specialists, and 8 contracted ambulance providers.