Complaints covered
- Claim or authorisation refused
- Unexpected co-payment
- Treatment or records complaint
Medical aid and healthcare
Claims, co-payments, authorisations, benefits and patient-service complaints.
Evidence to prepare
- Membership and claim numbers
- Clinical or provider documents
- Scheme decision and reasons
Escalation route
Council for Medical Schemes or relevant health authority
First give the organisation or public body a reasonable opportunity to respond and retain every reference number.
Your public summary must not contain identity numbers, banking information, medical records or private contact details.
Upload supporting evidence through the protected complaint workflow after signing in.