Claim rejected: provider was not a designated service provider
Your scheme says your doctor or hospital was not a designated service provider. What that means, and the questions to put to the scheme in writing.
The scheme says the provider you used is not one it designated for this service.
The wording to look for
- “not a designated service provider”
- “non-DSP”
- “outside the scheme's provider network”
Questions to put to your scheme in writing
- Which designated service providers were available to me for this service on the date of service?
- By what means, and on what date, was I notified of that designation before the date of service?
- Please provide the co-payment schedule the scheme applied, as it stands for my option this year.
- Was the service obtained in circumstances the scheme accepts as involuntary, and if not, on what basis?
Only you can answer these
- Whether you had a choice of provider, or the service was an emergency.
- Whether the scheme told you who its designated providers were before the service.
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.