Georgina Crouth reports:
Discovery Health has come under fire from medical practitioners for unethically “clawing back” claims it had approved and paid, well past even the three-year common law prescription period.
A medical aid fund must, in accordance with the Medical Schemes Act (MSA), query or dispute a claim within 30 days from the date of lodging, by providing written notice to both the fund member and the healthcare provider. The latter then has 60 days within which to respond and rectify the claim. If the scheme does not notify either party within 30 days that a claim is erroneous, or fails to allow correction and resubmission, the onus is on the scheme to prove the error.
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