Members should never assume that the Scheme has received an account, even if the provider has indicated that the account is for member information purpose only. Always forward the copy to the Scheme as well. Study your claims statements to ensure that claims were paid from the correct benefit and that you have in actual fact received the services / medication that a provider has claimed for.
MEDIMED members need to submit the following for claims to be processed effectively:
- Detailed Account (Patient name, medical scheme number, service date, tariff code/s & claimed amount are all important information needed on the account).
- A receipt for all medical expenses paid upfront (Remember that all medical expenses up to R650, except hospitalisation and chronic medication, must be paid upfront for members on the Alpha option).
- Pharmacy claims must include the invoice and a receipt/cash register slip (PAID stamp on invoice is not sufficient).
This will ensure that members are refunded timeously and are not unnecessarily out of pocket for any length of time.