How to make medical insurance claims

If you are on medical aid and you consulted a doctor on medical grounds where you paid cash up-front, you can easily get your money back from your medical aid insurance company. It is important to know what is required by the medical aid insurance company for your reimbursement amount to be processed without any hassles.

Documents required when claiming

Various documents are required by the medical aid company in order to process your claim. These documents are: Claim form You aree required to complete a claim form and the information required include your personal details, membership number or policy number, the amount claimed, the doctor’s details and his or her practice number, the service date, your bank account details and the patient’s dependencies, should there be any.
Doctor’s account This is the doctor’s statement or invoice which shows his name, address, practice number, details of the medical hospital, ICD and tariff codes. It also show the service date, the doctor’s fees, the purpose of the consultation, your details and the the details of the patient’s beneficiaries. Proof of payment The medical aid would require a confirmation that you have paid the doctor in form of a receipt to verify if it is not a duplicate claim. Sometimes, the proof of payment is irrelevant especially when the doctor’s account or invoice is addressed to your attention. How to file medical claims Medical insurance claims can be filed online through the medical aid claim company website by sending the claim form and the relevant documents via an email, fax or by hand delivering. Claim payment If your claim is authorised by the medical aid company, the money is directly sent to your account. In some cases, your claim may be rejected as a result of medical negligence or malpractice. However, if you are sure that it is a valid claim, you can seek the guidance of medical lawyers online.

Why claiming direct from medical aid

Up-front payments Some doctors require up-front payment before attending to you due to the following reasons: - You may be a new patient - Your medical aid company is still new in the market - Your medical aid membership is not activated or you are yet to receive your medical aid card However, if your doctor is among the panel of doctors recommended by your medical aid company and you are a fully-established patient, the doctor may claim directly from your medical aid company.