MedClaim Assist

MCA began operations is August 2016 and has since dealt with over 40 thousand claims and saved its clients more than R59 million.

Two recent examples of significant savings achieved on behalf of clients follow:

• A 74yr old woman fell and broke her hip. As there was extensive inflammation the required surgery was delayed for a few days to allow for the inflammation to subside increasing the chances for a good surgical outcome. Her claim was rejected on the basis that this was a case of voluntary use of a non-Designated Service Provider (DSP) – the scheme rules require that, for a case to be treated as an emergency, the surgery must be performed within 24 hours of admission. MCA made the clinical argument to the scheme that the 24 hour limit should not be applied in this instance. The scheme eventually paid the claim in full, saving our client R58,740.
• A 58yr old man suffered a hemorrhagic stroke and collapsed at home. His wife rushed him to the nearest doctor who immediately referred them to the nearest hospital. The scheme required an over R80,000 copayment as the hospital was non-DSP. MCA worked with the treating doctor to increase the accuracy of the coding on various invoices, sourced a letter of motivation from the doctor and negotiated with the scheme ultimately resulting in them paying R81,328.

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