Claim rejected during a waiting period: what to ask
Your medical scheme says you were still inside a waiting period. What that means, and the questions to put to the scheme in writing about how it was calculated.
The scheme says you were still inside a waiting period when the service was rendered.
The wording to look for
- “a waiting period applies”
- “condition-specific waiting period”
- “general waiting period”
Questions to put to your scheme in writing
- Which waiting period was applied, when did it start, and when does it end?
- What previous cover did the scheme take into account when imposing it?
- Please provide the certificate of previous membership the scheme relied on.
- Does the scheme apply that waiting period to emergency treatment, and how was that assessed here?
Only you can answer these
- The date your membership started.
- Which scheme you belonged to immediately before, and for how long.
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.