Health Insurance

About Medical Scheme Claim Assist

You pay a significant sum of money to your medical scheme every month and sometimes, when you claim for a legitimate medical expense, the scheme does not pay or only pays part of the claim. The reasons for the nonpayment may or may not be legitimate but, either way, you are left to deal with mounting doctor’s bills.

What we cover

At Constantia, we understand that it isn’t easy to rectify a mistake that has been made on a medical scheme claim and that taking on the process to correct the error can be time-consuming. We have developed a unique service that gives you peace of mind that your medical scheme payments and doctor’s bills are paid correctly, thereby minimising additional payments required from you.

What is different about our cover?

Our experts have solid medical knowledge and they understand the complex coding system, rules and regulations in order to assist you when a medical claim is short or not paid.

  • Send us your claim or invoice
  • This is processed through our claims engine
  • We provide feedback on how the claim should have been paid
  • If there is a discrepancy between our calculation and what was paid by your medical scheme, we identify where the problem lies
  • Armed with all the facts, we approach either your doctor or your medical scheme to sort out the problem

Divisions providing this solution