Medical Scheme statements can be confusing and are often complicated especially following hospitalisation, or treatment that extends over long periods of time.  

Some of the reasons claims are not paid in full from general funds are:

• The treatment is not identified as a Medical Emergency or PMB.

• Payments were incorrectly made using MSA money.

• The Diagnostic Invoices (Radiology and Pathology) were captured prior to the invoices from the treating Service provider.

• Incorrect ICD10 codes or price files were used.

• The invoice was captured incorrectly.

• Morphology codes are omitted.

Claims Hound can help.

• We critically analyse your statements and identify amounts that may be payable to you.
• You are provided with a detailed report to assist you in getting these amounts paid.
• Claims Hound Charges R20 per Medical Scheme Statement page with a minimum of R50 to do the analysis and provide the report.
• On receipt of the report, you can then decide to recover the amounts yourself or you can appoint Claims Hound to do so on your behalf.
• If you appoint Claims Hound to act on your behalf to recover the amounts due our fee is 15% of the amounts recovered.