Short-paid and unpaid claims
The scheme paid less than the account, or nothing, and left you to carry the gap.
Medical scheme advocacy · South Africa
Your medical scheme may owe you more than it paid.
We check your claims against the law and your scheme’s rules, then do the arguing for you. If we get money back or benefits approved, you pay a small, capped fee. If we do not, you pay no success fee.
Opening to members soon. Join the list to be first in.
Where members lose money
Four problems we deal with every day
Savings drained by mistake
Claims that belonged to the scheme's own benefits were charged against your Medical Savings Account.
Emergencies and PMBs
Treatment the law says must be paid in full, billed to you as a co-payment instead.
Treatment refused
A needed medicine or procedure declined, with no clear reason and no obvious way to challenge it.
How it works
Send the papers. We find the money.
- 1
You tell us
A short description of the problem, with your signed consent.
- 2
We analyse
Software flags items that look wrong. An advocate checks every one.
- 3
We argue it
We deal with the scheme, and the Council for Medical Schemes if needed.
- 4
You pay on results
A capped fee, only on money recovered or benefits increased.
Fair fees
A capped fee, charged only on results.
The success fee is a small percentage of what we recover, and it never goes above R3 500 on any one case. There is a small annual membership of R240 for one person.
Example
We recover R30 000.
Our fee is R2 600. You keep R27 400.
Free guides
Know your rights before you pay a cent
Emergencies and PMBs: when your medical scheme must pay in full
Landed in hospital in an emergency and your scheme left you with a bill? Learn when Prescribed Minimum Benefits must be paid in full, and what to check first.
5 min read →Money wrongly taken from your Medical Savings Account
Schemes sometimes pay PMB or hospital claims from your savings instead of risk benefits. Here is how to spot it on your statement and ask for it back.
4 min read →Questions
Straight answers
Do I pay anything if you recover nothing?
No success fee. You pay only when we recover money or get benefits increased, and the success fee never exceeds R3 500 on one case. The small annual membership starts once we accept your first case.
Can I not just do this myself?
Yes, and our free guides show you how. Many members prefer to hand over the statements, the scheme rules and the arguments to someone who deals with them every day.
Are you a law firm or a medical scheme?
No. We are an advocacy service. We work through your scheme's own dispute process and the Council for Medical Schemes, and we do not litigate.
Do you use Artificial Intelligence on my records?
We use Artificial Intelligence tools to read statements faster and flag items that look wrong. A person reviews every case, and nothing is sent in your name without sign-off. You will be told before any of your records are processed.
Is my medical information safe?
We treat health information as the most sensitive data we hold. We collect it only with your signed consent, only what the case needs, and we explain how it is kept in our privacy policy.
Ready to find out what you are owed?
Leave your details and we will contact you when we open for cases. No medical information needed yet.