Common complaints
- A claim or authorisation was refused
- An unexpected co-payment or benefit limit was applied
- Treatment, billing or access to records is disputed
Medical Aid and Healthcare Complaints in South Africa
Did your medical aid decline a claim or add a surprise co-payment? Submit your complaint and learn how to escalate to the Council for Medical Schemes.
What this complaint route covers
Use this route for medical-scheme claims, authorisations, co-payments, benefits and healthcare service complaints. First complain directly to the organisation or public body, keep every reference number and state the fair outcome you want.
Evidence to prepare
- Membership, claim and authorisation numbers
- Clinical or provider documents
- The scheme's decision and reasons
If it is not resolved
Escalate to: Council for Medical Schemes or the relevant health authority.
Your Complaintshub timeline and the organisation's replies can support the escalation.
How to make the complaint count
1. Set out the facts
Give dates, amounts, references and a short timeline. Separate what happened from what you assume.
2. Ask for a clear remedy
Explain whether you want a correction, refund, repair, explanation, restored service or another reasonable outcome.
3. Keep private details private
Do not put identity numbers, bank details, medical records or private contact details in the public summary.
4. Track the response
Use your account to see status changes and responses and to confirm whether the matter was resolved.
Supporting evidence remains protected. Publication follows the moderation policy, and formal rights and time limits continue to apply.