Christina had to get a special medical procedure, so she put in a claim with her medical aid and it was approved.
A month after her operation, Christina got a bill from the hospital saying her medical aid had only paid half the bill, and she needed to pay the rest.
Azikhiphi! That’s not on!
Christina didn’t know what to do. As a Scorpion member, she went to her nearest branch for help.
What does the law say?
If you have a complaint about your medical aid, you should first discuss it with the medical aid scheme.
If that doesn’t work, you can take it up with the Medical Schemes Council. You can send your complaints by letter, fax, or email.
The Medical Schemes Act 131 of 1998 states that your medical aid has 30 days to provide a response to the registrar of the Medical Schemes Council.
What is the Medical Schemes Council’s complaint procedure?
If you have filed a complaint with your medical aid scheme and feel the matter wasn’t handled correctly, you can approach the Medical Schemes Council to take the case further.
- Send your complaint in writing to the council or visit their offices.
- The council will send you confirmation in writing within three days.
- Once they have seen the response from your medical aid, the council will make a decision.
- Decisions or rulings will be made in four months.
- The council will let you and your medical aid scheme know what its final decision is.
Appealing the Medical Schemes Council’s decision
If you feel the decision made the by council was unfair, you have 30 days from the date of the ruling to file an appeal.
- The secretariat will give you and your medical aid scheme notice of the date and time of the hearing.
- After the hearing, the Appeals Committee will decide whether to keep the Medical Scheme Council’s ruling or change it.
How can Scorpion help you?
Depending on Christina’s policy, Scorpion can assist by speaking to her medical aid scheme on her behalf.
If there’s no solution, Scorpion will help Christina take the matter to the Medical Schemes Council.
If you want legal help, join Scorpion Legal Protection.
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