Med ClaimAssist Value Added Product: Terms and Conditions

The monthly subscription fee entitles the subscriber and their beneficiaries on their medical aid scheme to log unlimited queries with Med ClaimAssist whilst the fee is being paid.

No more than one claim at a time will be considered by Med ClaimAssist, i.e. multiple claims must be logged sequentially rather than all at the same time.

Each subscriber will be provided with a username and password to log queries with Med ClaimAssist.  The subscriber can login via the Med ClaimAssist website – www.medclaimassist.co.za in order to log a query.  If a subscriber is experiencing difficulty logging in, then they can request help by calling 0100205583 or emailing support@medclaimassist.co.za

After logging a query the subscriber will be provided with the name and direct contact details of the claims specialist assigned to their query.  The claims specialist will make contact with the subscriber in no longer than two working days of the query being logged.

Further documentation may be requested from the subscriber by the claims specialist.  In addition the claims specialist may request the subscriber to sign consent in favour of the specialist to allow them to access personal information at the medical aid and/or their doctor.  Failure to provide the consent may hamper the ability of the claims specialist to assist the subscriber.

The length of time to resolve queries varies dependant on the complexity of the query, and the medical scheme involved.  Anticipated time to resolution will be communicated through the system by the claims specialist.

The claims specialist will document their activity on the query on the Med ClaimAssist system.  The subscriber can, at any time, login via the Med ClaimAssist website and view the activity of the claims specialist in real-time.  Should the documentation on the system not be understood by the subscriber, the subscriber should contact the claims specialist directly with their questions.

The claims specialist will, where required, contact the treating doctor and/or the medical aid in order to attempt to resolve the query.

There is no guarantee that any individual claim will be resolved in the way that the subscriber wishes.  Where this is the case the claims specialist will provide a full explanation of why the outcome turned out the way it did.

Med ClaimAssist undertakes to keep the subscriber’s, and their beneficiaries’, data secure and compliant with all acts and regulations.  Where the subscriber is a client via the services of a broker, the broker will be able to see that the subscriber logged a query, but will not be able to see any of the detail of the query.

Med ClaimAssist Value Added Product (VAP) High Level Overview

Medical Aid benefits and exclusions are complex to understand and navigate.  Most members of medical aids experience, at one time or another, frustration, confusion, or anger when their medical aid denies and/or short pays a claim for medical care.  The byzantine rules, regulations, and procedures required by medical aids need detailed knowledge (both clinical and of the medical aid regulatory environment) on the part of the member to deal with problems and get these resolved.

These members often turn to their brokers for help.  Most brokers do not have the capacity to carry this level of detailed clinical and regulatory knowledge and themselves get frustrated at the time and energy needed to resolve medical aid problems.

Med ClaimAssist is a team of caring claims experts who take all this hassle out of brokers’ and members’ lives and handle of the queries efficiently, quickly, and accurately on behalf of members and patients.  Backed by detailed industry systems and databases the team is able to identify where the problem lies and intervene to solve it.  Whether the problem is coding errors on the doctor’s account, or processing errors by the medical aid – Med ClaimAssist identifies the issue and intervenes to solve it.

VAP clients of Med ClaimAssist have, for a small monthly fee, access to the full might and knowledge of the Med ClaimAssist team to stand behind them when they need help.  Logging a request for help through the personal login of VAP clients at the Med ClaimAssist website (or via the websites or apps of our partners) results in the request being assigned to one of our Claims Specialists.  The VAP client is given the direct contact details of the Claims Specialist and can track, in real-time, exactly what is being done on their query.  The claims specialist interacts with the member, doctor, and medical aid to get the best possible outcome for the member.

There is no limit to the number of queries a member can log over time (there is a limit to one query at a time though).

Med ClaimAssist takes the heat and tension out of resolving medical aid problems in a transparent and caring way for our clients.