Tips to get your medical bills paid

Gerhard Van Emmenis

Medical aid scheme options differ: some options cover procedures that others might not, but there are certain rules everyone must adhere to.

Membership number

Often an incorrect membership number or dependant code is submitted with a claim, or this information is omitted or incomplete. Update your details if you’ve changed your medical aid option or scheme.

ICD-10 codes

ICD-10 codes are used by medical schemes and healthcare providers to identify specific conditions. These must be correct as they’re a diagnosis for specific conditions. If there’s no ICD-10 code or, for some reason that condition isn’t covered by your medical aid, the account won’t be paid.

Schemes also have sub-limits.

Contributions aren’t up to date

Check that your debit order has gone through or that your employer has paid your contribution. Non-payment of premiums could result in your bill not being paid.

The claim has expired

There is a cut-off date for submitting a claim – usually four months from the date of treatment. Ensure the correct date is on the top of the account.

Your benefits are depleted

If you don’t manage your medical aid benefits carefully you can run out of benefits before the end of the year and you may have to pay the bill yourself.

Waiting periods may apply

When you join a new scheme there’s a waiting period of three months and sometimes, based on your medical history, a 12-month exclusion could be enforced for certain conditions.

Your hospital/doctor isn’t on the network

Most schemes have hospital and doctors networks who agree on certain rates for their members. If you choose to go to another hospital or a private doctor you could end up paying a large portion of the bill.

You didn’t use designated service providers

A designated service provider is a specific provider that has been appointed by a medical scheme for a specific service. If you choose not to use a designated service provider, you may have to pay a co-payment or not be covered.

Pre-authorisation wasn’t obtained

To undergo a procedure you need authorisation from your medical aid before going to hospital.

You’re using medicine not on the formulary

Every scheme has a formulary, which lists chronic medication approved by your medical aid.

Gerhard Van Emmenis is principal officer of Bonitas Medical Fund.

It teaches you to save first and decide what to save for.

Work towards your dreams –

An emergency fund should cover three to six months of your living expenses. Build a payment plan into your budget and start growing the fund as soon as possible.

Prepare for emergencies – Keeps your credit score healthy –

35% of your credit score is based on your payment history and 30% on your debt-to-credit ratio. By paying your bills on time and paying down your debt, you’ll boost your credit score, so you’ll have an easier time qualifying for loans.

Craig Hutchison is CEO of Engel & Völkers Southern Africa.