We look out for you!
Helping to get your claims paid
Who is Med ClaimAssist?
Med ClaimAssist was founded to help medical aid members when a medical claim is short or not paid.
We know that it isn’t easy to fix a mistake that has been made on a medical aid claim – especially for a layperson. In addition, taking on the process to fix the error can be a time-consuming process at best. This is where our experts come to your aid.
We can resolve these issues 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 for you.
WE’VE GOT THE KNOW-HOW:
We realise that you pay a significant premium to your medical scheme every month. However, sometimes when you do end up having to claim for a legitimate medical expense, the scheme either doesn’t pay or part pays your claim, leaving you to deal with mounting doctors’ bills.
Our Mission Is to Help You Get Your Claim Paid
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.
How we help you handle your medical claim:
Send us your info
You send us your claim or invoice, and we process it through our claims engine.
We ask you to send us more details of the problem – like doctor and hospital invoices, medical aid statements, and so on.
Additional information, such as that provided by your scheme when they processed the claim may be requested by us.
We Find the Answer
We evaluate (at no cost to you) your situation based on the documents you send us.
We provide feedback to you on how the claim should have been paid.
If there is a discrepancy between what was paid by your Medical Scheme and our calculation of what should have been paid, we identify where the problem lies.
If, after the evaluation, we believe that we cannot help you, we get back to you and explain why we cannot help and there remains no charge to you.
We Take Care of It
If we believe that we can help, we get back to you and explain what we will do – we will need you to sign a consent form so that we can interact with your medical aid and doctor on your behalf.
If we take the case forward our fee is R575 (inclusive of VAT) OR we can provide the service at no cost if you appoint one of our partner intermediaries as the intermediary of record for your medical aid. This does not cost you anything but does mean that the intermediary will be paid a commission by the medical aid thereafter.
Get Your Claim Paid
Tell us about your claim