Netcare Medical Scheme
Non-payment of claim

A dental procedure was performed on my daughter on 15 September 2011 and the claim was subsequently submitted directly thereafter by the dentist. I was informed in the beginning of February 2012 by the dentist that they were not paid. I faxed a copy of the invoice to Netcare medical scheme on 7 February 2012 and e-mails were sent to Netcare, to no avail and no reply. I resubmitted the documentation again on 14 January 2013 and again on 30 January - no feedback was given. I phoned again and was told that Netcare Medical Scheme was under new administration and the claim is considered 'stale' and is rejected. How can a claim that was continually being submitted and followed up on be considered as stale? I did everything in my power to ensure that the claim reaches the scheme, so the claim is rejected because the scheme did not do their part and I have to pay for it. This is nonsense and will be reported to the ombudsman.

Company: Netcare Medical Scheme
Country: South Africa
City: Alberton

  <     >