Medical aid claim submitted late: what to ask your scheme
Your medical scheme says your claim arrived outside the period its rules allow. What that means, and the questions to put to the scheme in writing.
The scheme says the claim reached it outside the period its rules allow.
The wording to look for
- “the claim was submitted late”
- “stale claim”
- “outside the claim period”
Questions to put to your scheme in writing
- On what date did the scheme receive this claim, and by what route?
- What is the submission period in the registered rules, and from what date does it run?
- Please provide the record of any earlier submission of this claim.
- Does the scheme consider late claims where the delay was not the member’s doing, and what does it require?
Only you can answer these
- When your provider says they submitted the claim.
- Whether the claim was submitted, rejected on other grounds, and resubmitted.
Paste your rejection notice and build the letter. It is read on your own device and never uploaded.
See every reason a South African medical scheme gives.
Pryse is not a law firm and does not act for you. Nothing here is a determination of your rights or legal advice, and no registered scheme rule is quoted. The questions ask your scheme to provide its own.