TM
Tlotlo M
1 reviews | Active since Apr 2013
06 Mar 2015, 12:16
Non payment
Hi, I went for an operation in June. The doctor send his invoice to my Medical Aid (CAMAF) a week after my operation. The invoice kept on being rejected by them. I finally got hold of the invoice after numerous attempts by the doctor to get this paid. I decided to pay it and sent through this claim on 2014-12-02 and I called a week later trying to find out what the issue is. A consultant told me that December it's their cooling period and I should call back in January 2015, January 2015 I call back and I'm being told that my claim it's being processed I will get my money back the following week. Today March 6th 2015 I call CAMAF back and talk to a lady by the name of Paulette de Bruin who is a Senior consultant at CAMAF call center and she tell me they will not pay my money because the claim is late it's 4 months after the effect. Why are they refusing to pay my money back because the doctor kept on sending an invoice and they kept rejecting it. The invoice was made for R 2 073.30 which I ended up paying from my pocket UN-budgeted for because the medical aid which I pay every month refused to pay it. WHY?
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Camaf's replyOfficial
06 Mar 2015, 13:09Hello TlotloM,
Please be advised that we have not received your claim prior to 02 December 2015. Also, according to your membership records, the claim was not queried by yourself or your doctor within the 4 month claiming period.
The claim was initially received 02 December 2015 and captured for remittance dated 05 December 2015, which is after the 4 months claiming period.
As per the medical schemes act, all claims need to be submitted to the scheme within 4 months from the treatment date. It is important to note that it remains your responsibility as the member to ensure that your claims are submitted to the scheme within this period.
We will request the proof of previous submission from the practice so that we may have the stale claim reviewed for payment.
Yours in Health,
Tertia Louw
Client Relations Supervisor
Please be advised that we have not received your claim prior to 02 December 2015. Also, according to your membership records, the claim was not queried by yourself or your doctor within the 4 month claiming period.
The claim was initially received 02 December 2015 and captured for remittance dated 05 December 2015, which is after the 4 months claiming period.
As per the medical schemes act, all claims need to be submitted to the scheme within 4 months from the treatment date. It is important to note that it remains your responsibility as the member to ensure that your claims are submitted to the scheme within this period.
We will request the proof of previous submission from the practice so that we may have the stale claim reviewed for payment.
Yours in Health,
Tertia Louw
Client Relations Supervisor
Best regards,
Camaf's reply06 Mar 2015, 13:09
Official
Hello TlotloM,
Please be advised that we have not received your claim prior to 02 December 2015. Also, according to your membership records, the claim was not queried by yourself or your doctor within the 4 month claiming period.
The claim was initially received 02 December 2015 and captured for remittance dated 05 December 2015, which is after the 4 months claiming period.
As per the medical schemes act, all claims need to be submitted to the scheme within 4 months from the treatment date. It is important to note that it remains your responsibility as the member to ensure that your claims are submitted to the scheme within this period.
We will request the proof of previous submission from the practice so that we may have the stale claim reviewed for payment.
Yours in Health,
Tertia Louw
Client Relations Supervisor
Please be advised that we have not received your claim prior to 02 December 2015. Also, according to your membership records, the claim was not queried by yourself or your doctor within the 4 month claiming period.
The claim was initially received 02 December 2015 and captured for remittance dated 05 December 2015, which is after the 4 months claiming period.
As per the medical schemes act, all claims need to be submitted to the scheme within 4 months from the treatment date. It is important to note that it remains your responsibility as the member to ensure that your claims are submitted to the scheme within this period.
We will request the proof of previous submission from the practice so that we may have the stale claim reviewed for payment.
Yours in Health,
Tertia Louw
Client Relations Supervisor
Best regards,