Can I as a service provider refuse to attend to an enrollee’s medical needs?
No, you cannot; As long as the presenting complaint is covered under the scheme, and the enrollee’s Capitation has been paid( where Capitation applies), or an indication has been given in writing that we shall deal on Fee-for-Service with you (where Capitation does not apply); In the strictest sense of the word, the doctors must answer to the needs of every patient whose capitation has been paid. Capitation is the key determinant of whether our patient gets medical attention or not; However, if the enrollee presents with what forms part of the exclusion list or with a relation who is not duly registered on the scheme, the doctor has every right to refuse attention to such errant enrollees, and also inform Zenith Assurance Medicare.
