Was your medical aid claim denied?

Just read what these people had to say after receiving assistance from experts in the industry . . .

"What a helpful company!! If you are struggling with your medical aid that doesn't want to pay and they have so many excuses and they don't want to pay and you are not in the medical field to understand the terms and conditions or the medical wording, this company will assist you and get the medical bills paid. Very helpful and friendly people that are extremely professional." This is what a client named Letitia wrote about MedClaim Assist on Hellopeter.

Another person on Hellopeter, John, writes: "My wife died four months ago and after only one week I got an account stating that I had to pay in an amount of R47 000. This is [Medical Scheme Name] for you. I had a hospital plan and was under the opinion that all would be paid for. Best of all you are told that you have to use [hospital name] hospitals. My wife was admitted to the Margate hospital with a lung infection. They needed her to see a pulmonologist. This took six days to find a Netcare hospital in KwaZulu with a bed and a specialist, six days of no meds. As the saying goes – and this was the case – a dying shame. I was desperate and my daughter found a notice on the internet for MedClaim Assist. We were contacted by an angel called Dagmar, who fought the case for us. We have just received an email from her, and our total debt is now R2 000."

If these people’s struggles with medical aid bills and claims sound familiar to you, you probably need MedClaim Assist (MCA).

People are often confused – or furious – when their medical aid claim is denied. Finding out where the problem was then often entails going up and down and spending hours on the phone, while you may still not understand what is going on – even if the fund does answer you.

MCA are experts in the field of medical aid jargon, terms and conditions, as well as how to claim and what you are allowed to claim for. It’s a friendly voice on the other side of the phone who knows what’s going on and what questions to ask, who can now take on the struggle to find out what went wrong and whether the fund didn’t perhaps make a mistake in denying your claim.

And if you think you can do it without them, ask yourself the following: do you know what prescribed minimum benefits mean, and what those are for your medical aid scheme? Do you know what is a non-payment gap? Do you know which benefit your claim should have been paid from, or whether your medical scheme is paying out your savings correctly? And don’t you think it would be much more convenient and less stressful if you had someone who understands all this and could sort it out for you?

MedClaim Assist can do all this, and if there was a mistake made on an invoice and which is preventing payment, they will contact the medical aid for you and sort it out.  This team of experts has handled more than 45 000 claims in the past four years, and have saved their clients more than R43 million.

How it works

1. You send them your claim or invoice, and they process it through their claims engine. They might ask you to send them more details – doctors’ or hospital bills or invoices, medical statements and so on.

2. They find out what’s going on for FREE, and give you feedback. If they think they can’t help you, you owe them nothing at all. But if there is, for example, a difference between what your medical aid paid you and what they calculated you should be paid, they’ll find out where the problem lies.

Payment

• You can choose one of three methods to pay – if it seems you do need their services.
• A once-off payment of R575 for one claim.
• A monthly subscription of R39 per month.
• A one-year subscription for R399 (you get two months free).

Your subscription includes the following:

• Unlimited queries and assistance as long as the subscription is active.
• Pro-active controlling of doctors’ invoices and the medical aid’s reaction so problems can be identified and solved.
• If you have gap cover, assistance with submitting claims to your gap cover insurer.

For more information, go to MedClaim Assist.