Medical Schemes often do not pay everything they should for Medical Emergencies and other Prescribed Minimum Benefit (PMB) treatments.

Medical Emergencies must be paid for in FULL by the Medical Scheme, even if the medical service provider is NOT a Designated Service Provider (DSP) including related services such as pathology and radiology.

Under specific conditions non-Emergency PMBs are payable in FULL.

Claims Hound can help.

• We analyse your Medical Scheme Statements and Medical Service Provider Invoices to determine whether the treatment qualifies as a PMB, and if it should be paid in full.
• We engage with the Medical Scheme on your behalf to get the treatment classified correctly.
• No need for you to get directly involved in the negotiations with the Medical Scheme.
• You are notified when the Medical Scheme agrees to increase the benefits payable.
• The increased amount will be made either to you or the medical service provider depending on the rules of the Medical Scheme.
• On confirmation by the Medical Scheme that payment has been made, Claims Hound will invoice you for 15% of the increased amount (our service fee).