If the dispute with your medical scheme failed, a complaint may be lodged with the Council for Medical Schemes (CMS).

If you are unsuccessful in getting your claims paid by engaging with the Medical Scheme or where the Medical Scheme refuses to provide approval for the benefits you require you may lodge a complaint to the Council for Medical Schemes (CMS). 

This is a complex process, and you need to ensure that your arguments are well presented, with supporting documentation and references if you want to be successful. 

Further appeals are possible should you be dissatisfied by the decisions of the CMS. 

Failing to comply with the process and time frames may result in you losing your claim.

Claims Hound can help.

• We assist with the preparation and submission of the complaint and/or appeal.

• We deal with any queries CMS may have.
• We provide you with regular progress updates.
• If the CMS ruling results in increased benefits payable to you or the Medical Service Providers, Claims Hound will invoice you for 15% of the increased amount (our service fee).