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What can lead to refusal of emergency cover

Here are 3 quick checks you should do to ensure that, no matter the situation, you will always have peace of mind when requiring medical care.

By Alex Searle

If you find yourself on the medical aid section on Hellopeter.com, it doesn’t take long to notice that an alarming proportion of medical aid schemes have shamefully low trust ratings and reviews.

South Africans are nothing if not discerning consumers, and while they are mostly fair, they will not hold back if they’ve been on the receiving end of a bad service experience. While we can’t speak for our friends in the industry (who no doubt need to keep a close eye on Hellopeter to rectify when and where needed), we wholeheartedly embrace the right of South African consumers to have their voices heard when they feel strongly about an experience they’ve had, whether it’s positive or negative.

In doing so, much of the negative review content has to do with delayed authorisations, rejected claims and declined benefits. This is especially true when the reviews have been written about emergency situations. While many of these are simple administrative errors or delays, which are often handled timeously, we also realise that it’s become a common trend (even a running joke) to simply ‘have a go’ at the medical aid provider when, in reality, there are policy documents detailing the precise criteria a member must satisfy in order to qualify for PMBs (Prescribed Minimum Benefits) or other medical aid benefits.

Unfortunately, in these kinds of ‘battles’, no one wins – least of which the member requiring treatment.

For us at Selfmed, knowledge is key. Here are 3 quick checks you should do to ensure that, no matter the situation, you will always have peace of mind when requiring medical care:

1)    Don’t fall behind on your premiums

It’s unfortunate because it’s something that you’d normally think would be taken care of, but this so often happens. Always ensure that your monthly premiums and/or gap cover payments are up to date. If you’re behind on even one, your membership runs the risk of immediate suspension and your benefits will be rescinded. So please make sure that your debit orders go off correctly every month.

2)    Where’s my medical aid card?

Once again, a silly mistake, but often committed. Not having your medical aid card handy could place you at risk of not receiving medical treatment. Some service providers may accept a verified form of your ID. But to avoid any tricky situations, just have your card in your wallet, ready for action.

3)    Elective surgeries

If you’re on a medical aid plan that only covers PMBs, you will almost certainly have no coverage when it comes to elective medical procedures. Elective procedures are those which can be scheduled in advance or do not require immediate life-saving medical attention, like taking your appendix or tonsils out.

Make sure you know the benefits that your medical aid option covers, so that you can spend more time leaving good reviews on Hellopeter instead of bad!

Learn more: www.selfmed.co.za

*Image by Steve Buissinne from Pixabay


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