Your Free Medical Scheme Alternative Dispute Resolution Service
Policyholders will also be able to access the MedCare service for all claims that fall outside the R12 000.
Legal action is expensive. The term alternative dispute resolution (ADR) refers to a procedure, agreed to by conflicting parties of a dispute, in which they use the services of a neutral party to assist them in reaching agreement and avoiding costly litigation. Section 29(1) (j) of the Medical Schemes Act compels medical schemes to contain the process how members can resolve complaints and/or disputes. Section 47 to 50 of the Medical Schemes Act also allow aggrieved parties to lodge complaints with the Registrar of Medical Schemes and allow for appeals if an aggrieved party is dissatisfied with a decision or ruling.
Free and comprehensive information is available on the information hub to all Sirago policyholders. Here is information about your rights as a member of a medical scheme, self-help guides, previous case law and templates to name a few resources.
You will have to decide if you want to lodge a dispute or complaint yourself if you want to use your broker or if you want to use the services of a MedCare ADR Practitioner.
Should you want to use your ADR practitioner then you can do so by clicking on the ADR practitioner button on the information protal. If your claim relates to a Gap cover claim and is above R 12 000 then the ADR services will be free of charge. Claims below R 12 000 or any other aspect relating to your medical scheme can still be referred to your ADR practitioner. However, there will be a fee applicable to those cases.
Even though not a GAP claim, MedCare helped me to resolve my short-term insurance claim. Your involvement increased my payout after my house burnt down with R300 000. I cannot thank you enough.
Thank you MedCare team for taking on my husband's case with the CMS. My husband was hospitalised for Covid and MedCare you assisted in getting the short payment for a PMB paid. That saved us R16 000, and even better is that I did not have to claim it from our GAP cover. Excellent work done.
Thank you MedCare for ensuring that my medical scheme refunded me for physiotherapy treatment. The amount was not huge, but it was the principle that was important. You guys ROCK!
My Claim of R 477 000 was fully paid as a PMB after MedCare took the matter to the CMS on my behalf. Thank you Medcare team!
Thank you MedCare team for taking on my case with the medical scheme. I was hospitalised and had to use a hospital outside the network for a PMB. My claim was R5 000 was paid, and I did not need to claim from my GAP cover. Fantastic and competent, MedCare assisted me all the way.
Thank you, MedCare. Even though it was not a Gap claim, you helped me resolve my short-term insurance claim. Your involvement ensured that a car damage claim was paid in 48 hours, when the insurance procrastinated for more than a year and eventually refused to pay.