Are you often puzzled – or even angry – when you receive a notification from your medical aid to say that a claim has not been paid? Quite often a mistake has been made and it is not easy to know whether this is the case. Why not let us help you? We can tell quickly whether the claim should have been paid.
Do you understand the ins and out of Prescribed Minimum Benefits (PMBs)for example? Or what is meant by “non-payment gap”? Do you know which benefit your claim should have been paid out of? Is your Medical Scheme paying out your savings correctly?
We can sort these issues out quickly – and, if an error has been made either by your doctor (on the invoice) which is preventing payment from happening properly, or by your medical aid, we will approach them and get the problem sorted out for you. Click here to contact us.
Medical Scheme Problems
You pay a large sum of money to your Medical Scheme every month. Then, when you do end up claiming for a legitimate medical expense, the Scheme either doesn’t pay or part pays your claim leaving you to deal with the doctor’s rooms asking for their money.
Why does this happen, and can anything be done about it?
Sometimes the reasons for the non-payment are legitimate, and sometimes not. Sometimes the problem lies with the doctor’s rooms (or other service provider) not entering the correct code on the claim to the Medical Scheme, and sometimes the problem lies with the Scheme not processing the claim correctly. Either way sorting the problem out needs detailed understanding of complex coding systems, rules, and a bit of medical knowledge thrown in. More often than not this means the patient ends up paying providers when the Scheme is liable and should have paid.
Med ClaimAssist analyses your claims, identifies where the problem lies and approaches the source of the problem (be it the doctor’s rooms or the Medical Scheme) with all the facts, rules, and regulations lined up and assists you in getting the doctor paid.