MEDICAL SCHEME SUPPORT


Assistance and support with claim issues

You’ve had a medical procedure or had to consult with a doctor, and the medical scheme informs you the claim has been rejected or there is a co-payment you were not aware of. You actually thought that you had full cover…What now?

Or, you suspect that your claim relates to a Prescribed Minimum Benefit (PMB) –  a diagnosis, treatment and care forming part of 270 life-threatening conditions and 25 chronic conditions which the scheme are obliged by law to cover. But, you’re not sure how to confirm that it is in fact a PMB and have it processed accordingly…

Your MedXpert consultant is there to ensure a smooth running claims procedure.

They are able to liaise with the scheme and to assist with the investigation to get the answers and possible solution with regards to the unpaid or incorrectly paid claim.

It is often wise to consult with your MedXpert consultant before the procedure or consultation to ensure you are following the rules and regulations of your specific option and its benefits. This way you could avoid unnecessary expenses or penalties.