Solving Your Medical Aid Non-Payments
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 providers) 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 a 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.
MediCheck analyses your claims, identifies where the problem lies and approaches the source of the problem (be it the doctor’s rooms, pharmacy or the Medical Scheme) with all the facts, rules, and regulations lined up and assists you in getting the doctor and other Medical providers get paid.
Protecting “Your Health and Your Rights”
MediCheck assists and protects the Members of Medical Aid Schemes and informs them about their rights, obligations and other matters, in respect of Medical Aid Schemes
MediCheck ensures the swift resolution of queries raised by members of Medical Aid Schemes, and are handled appropriately and speedily.
Understanding PMB and CDL
Prescribed Minimum Benefits (PMBs) are a set of defined
benefits to ensure that ALL Medical Scheme Members have (whether on a Comprehensive Plan or a Hospital Plan) access to certain minimum health services, regardless of the benefit option they have selected.
The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable.
PMBs are a feature of the Medical Schemes Act, in terms of which medical schemes have to cover the costs related to the diagnosis, treatment and care of:
- any emergency medical condition
- a limited set of 270 medical conditions: and
- 25 chronic conditions defined in the Chronic Diseases List (CDL)
Medical Schemes MUST pay in full, without a co-payment or the use of deductibles, for the diagnosis, treatment and care costs of the Prescribed Minimum Benefit conditions.