Seven steps from a bad statement to a corrected one

1. 1

   You tell us what happened

   Describe the problem in a few lines. We tell you honestly whether it looks worth pursuing, before you spend anything.

2. 2

   You sign a consent

   Schemes will only release your information to someone you have authorised in writing. You sign a third-party consent form, and we explain exactly what we will see and why. Health information is special personal information under POPIA, so we collect only what the case needs.

3. 3

   You send the papers

   Your scheme statements and the provider invoices for the period in question. We will tell you what is missing.

4. 4

   We analyse the claims

   Artificial Intelligence tools read the statements and flag items that look wrong: MSA deductions, co-payments on PMBs and emergencies, short payments. An experienced person then checks every flag. Software finds candidates. A person decides.

5. 5

   We take it up with the scheme

   We write to the scheme, quote the rule or regulation, and ask for the claim to be corrected. You are updated at each stage and nothing is sent in your name without your approval.

6. 6

   We escalate if needed

   If the scheme will not move, we prepare and lodge a complaint with the Council for Medical Schemes, handle its queries, and help with an appeal if the ruling goes against you. The Council publishes target times of weeks to months, so we set that expectation early.

7. 7

   You pay on results

   When money is refunded or benefits are increased, we invoice a capped success fee. If we recover nothing, there is no success fee.

General information only, not legal, medical or financial advice. Scheme rules and regulations change, and every case turns on its own facts. We cannot guarantee any outcome.