Members of medical schemes are strongly advised to contact their schemes PRIOR to admission to hospital to find out what payment arrangements they must make if any. Some schemes may pay only a portion of the hospital bill directly to the hospital in which case the member will have to make arrangements to pay the difference. Other schemes may not pay the hospital at all but may refund the member a portion of the bill. In this case the member may be required by the hospital to make some kind of payment in advance or supply a guarantee of some kind that payment will be made or both.
Yet other schemes may pay the bill in full directly to the hospital in which case there is unlikely to be a charge to the member.
Complaints in regards to Medical Schemes.
HASA recommends that members who have complaints in regards to any Medical Scheme, that they attempt to resolve such with the Scheme directly. In terms of the Act, all Schemes are required to have a 'dispute committee', which is responsible for the handling of such complaints. Members should contact their respective Scheme and request details in this regard. It is also recommended that complaints be submitted in writing.
If for whatever reason it is not possible to resolve the complaint with the Scheme, then the member may contact the Registrar of Medical Schemes and lodge the complaint with his office. The procedure for which is as follows:
- Put together and Affidavit, in which all the details of your complaint are recorded, together with any relevant documentation (which should be attached).
- Address the complaint to the Registrar of the Medical Schemes Council.
- Lodge this complaint within three months of a decision of the 'Dispute Committee', and no later.
