Turn a rejected claim into questions your scheme must answer

Paste the rejection notice your medical scheme sent you. Pryse shows which reasons it recognised, quoting your own words back so you can check them, then assembles the questions into a letter you send in your own name.

The notice is read on your own device. No network request is made, nothing is stored, and nothing is sent to any service.

Reasons South African medical schemes give

• Not treated as a Prescribed Minimum Benefit · The scheme says this service does not fall within the Prescribed Minimum Benefits.
• Provider was not a designated service provider · The scheme says the provider you used is not one it designated for this service.
• Pre-authorisation not obtained · The scheme says it did not authorise the service before it was rendered.
• Medicine not on the formulary · The scheme says the medicine claimed is not on the list it funds for your option.
• Benefit exhausted · The scheme says the benefit this claim would have been paid from is used up.
• Sub-limit applied · The scheme says a specific per-item, per-person or per-family cap applies to this claim.
• Co-payment or deductible applied · The scheme says part of the cost is yours to pay under its rules.
• Charged above the scheme rate · The scheme says the provider charged more than the rate it pays, and it funded its rate only.
• Treated as an excluded service · The scheme says its rules exclude this kind of service from cover.
• Waiting period applied · The scheme says you were still inside a waiting period when the service was rendered.
• Condition not registered for chronic benefits · The scheme says the condition was not registered with it for chronic cover when the claim was made.
• Claim submitted late · The scheme says the claim reached it outside the period its rules allow.