1 reviews | Active since Mar 2015
Claim rejected
<p>I submitted a claim after going to a biokineticist for a fitness assessment. Biokinetics is covered under the supplementary health benefit of my membership option (Essential plus), subject to the availability of funds in the medical savings account. I confirmed before visiting the relevant practitioner that he is affiliated with CAMAF and ensured that I have enough funds available in my MSA. I submitted the claim, but it was rejected because "The procedure is not covered by the fund". I sent an email to customer services, but the automatic response said to post the original claim to CAMAF - something that is a lot more trouble than it is worth. This is the second claim (of the two I submitted myself thus far) that was rejected even though I was under the impression that the procedure was covered by the fund. If I am misinterpreting the brochure I downloaded from your website, please advise. Otherwise please advise how I can amend the problem without a trip to the post office. I will happily correspond via email to resolve this issue.</p>
Just saw another HelloPeter user who complained about the same problem. The answer you gave that user differs from the response I got on an email sent to CAMAF. In that case you investigated and found that the wrong tariff code was used on the invoice from the practitioner. Could this be the problem in my case as well?
Just saw another HelloPeter user who complained about the same problem. The answer you gave that user differs from the response I got on an email sent to CAMAF. In that case you investigated and found that the wrong tariff code was used on the invoice from the practitioner. Could this be the problem in my case as well?
Good day Stefan
Your enquiry is being investigated. We will provide you with feedback shortly.
Kind regards
Alicia Dalais
Client Relations Manager
Good day Stefan
Your enquiry is being investigated. We will provide you with feedback shortly.
Kind regards
Alicia Dalais
Client Relations Manager
Good day Mr Bezuidenhout,
Kindly be advised that the Biokinetist Fitness Assessment is a scheme exclusion. However, the Biokinetics Fitness assessment may be covered subject to availability of positive medical savings.
Explanation of your medical savings:
Your normal medical savings (msa) is what is allocated to you at the beginning of the year, in simple terms it would be referred to as a credit provided to you for the year. The msa is then paid back to the scheme on a monthly basis from January until December.
If for example, you use more msa than what you have paid back to the scheme, you will then have a negative balance until you have paid back the full amount of msa at the end of the year.
Or if you do not use medical savings for a few months, the funds then become what is called positive medical savings which you have accumulated up to date.
I trust this information is useful to you.
Yours in Health,
Tertia Louw
CAMAF: Client Relations Supervisor
Good day Mr Bezuidenhout,
Kindly be advised that the Biokinetist Fitness Assessment is a scheme exclusion. However, the Biokinetics Fitness assessment may be covered subject to availability of positive medical savings.
Explanation of your medical savings:
Your normal medical savings (msa) is what is allocated to you at the beginning of the year, in simple terms it would be referred to as a credit provided to you for the year. The msa is then paid back to the scheme on a monthly basis from January until December.
If for example, you use more msa than what you have paid back to the scheme, you will then have a negative balance until you have paid back the full amount of msa at the end of the year.
Or if you do not use medical savings for a few months, the funds then become what is called positive medical savings which you have accumulated up to date.
I trust this information is useful to you.
Yours in Health,
Tertia Louw
CAMAF: Client Relations Supervisor
You guys should offer an induction course for new members so everyone can be on the same page. With all the rules, exceptions to rules and exclusions from the exceptions nobody will ever understand what they are actually paying for and continue to feel like they are throwing money in the water every month and wondering if it is even worth while.
It seems like medical aids are just looking for new and creative ways to avoid paying out a claim. I know my claim is very small and I will survive without being refunded the money, but the principle stands.
I have been contributing to the medical aid (CAMAF specifically) for just over a year now, with contributions totalling close to R30000 – and my claim total for the period is about R5000. That means that you scored R25000 in this period. Unless I develop some serious disease that requires specialised treatment, or get injured in an accident I will propably never see that money again. Lets hope.
You, as the medical aid, know that we need this cover just in case something happens, while knowing all too well that the propability of each member claiming an amount exceeding their accumulated contributions is very low. Still, you make it increasingly difficult to claim for expenses aimed at keeping members in good physical health.
In some sense I should feel good about giving you this money so you can pay for someone elses medical expenses. Pity I can’t deduct it as a donation for tax purposes.
The best thing that came from my membership with CAMAF is your loyalty programme, Multiply, that at least gives me some benefit for my monthly contributions – even though it still does not add up to the R25000 and draws its own membership fees.
You needn't respond to this reply. I had to vent my frustration in some way.
You guys should offer an induction course for new members so everyone can be on the same page. With all the rules, exceptions to rules and exclusions from the exceptions nobody will ever understand what they are actually paying for and continue to feel like they are throwing money in the water every month and wondering if it is even worth while.
It seems like medical aids are just looking for new and creative ways to avoid paying out a claim. I know my claim is very small and I will survive without being refunded the money, but the principle stands.
I have been contributing to the medical aid (CAMAF specifically) for just over a year now, with contributions totalling close to R30000 – and my claim total for the period is about R5000. That means that you scored R25000 in this period. Unless I develop some serious disease that requires specialised treatment, or get injured in an accident I will propably never see that money again. Lets hope.
You, as the medical aid, know that we need this cover just in case something happens, while knowing all too well that the propability of each member claiming an amount exceeding their accumulated contributions is very low. Still, you make it increasingly difficult to claim for expenses aimed at keeping members in good physical health.
In some sense I should feel good about giving you this money so you can pay for someone elses medical expenses. Pity I can’t deduct it as a donation for tax purposes.
The best thing that came from my membership with CAMAF is your loyalty programme, Multiply, that at least gives me some benefit for my monthly contributions – even though it still does not add up to the R25000 and draws its own membership fees.
You needn't respond to this reply. I had to vent my frustration in some way.