• In Hospital Claims

    We have extensive experience and knowledge in PMB’s
  • PMB Claims

    The payment of Prescribed Minimum Benefit Claims (PMB) are regulated by Council of Medical Schemes......
  • Emergency PMB Claims

    Emergency PMB Claims must be settled in full by the Medical Scheme.......
  • Pricing

    Medwyze charges a standard administration fee on all.....

blanker

  

medwyze helpyourmedialclaims

 

Hospital Event

Whether a planned visit, an emergency visit or a treatment that involves investigative procedures (scans or scopes); Medwyze will check the Hospital, Doctors' and Specialists' bill to determine whether the costs are relevant and in line with the treatment you received and to confirm the accuracy of the settlement by your medical aid.

Too often members of medical schemes have to pay in (co-pay) on their medical accounts due to incorrect billing or coding, however it is important to note that specific rules of the scheme provides for co-payments where non network doctors or hospitals are used.

Our team specialises in ensuring that co-payments are valid and that you, the end consumer, are not unfairly billed.

 


Prescribed Minimum Benefit Claims (PMB)

 A PMB claim is a medical event which is defined in the Medical Schemes Act as an event where the Medical Scheme is obliged to pay the full cost of the claim without co-payment or deductible (regardless of the value). However, to protect their risk, Medical Schemes are allowed to contract with hospitals and providers to control the cost (network providers)

If your claim is coded as a PMB and you have used the correct doctor or hospital and still have shortfall on your account, Medwyze will investigate and resolve this on your behalf.

 A PMB claim is not just the treatment, but can also be the original consultation, scope, scan or X-Ray that results in the end treatment. All of these bills are investigated by Medwyze and where necessary re-processed. 


Emergency PMB

An emergency is stressful enough for the family and individual involved but the resulting bills can be even more stressful. An emergency is defined as 'urgent treatment preventing loss of life and/or limb' and treatment must be rendered within 6hrs. of the injury or event. 

Medwyze has a Clinical team specifically trained to investigate emergency procedures.  This clinical and investigations team consists of paramedics and trauma nurses who have years of experience in treating emergencies.

In the event that the event is a confirmed emergency the Medical Scheme is obliged to cover the cost in full regardless of the rules of the scheme.

These accounts are investigated by Medwyze and where necessary re-processed. 


Pricing

Individuals and Families

  • Option 1: Administration fee of R250.00 per patient per event
  • Option 2: Monthly fee of R35.00 per family via debit order regardless of the number of events

Large Corporates

  • Monthly fee of R35 per employee paid via payroll.

The monthly fee service includes unlimited calls to our clinical and investigations department to confirm whether your procedure will be covered in full by your medical aid or not. This is  completely independent of the pre-authorisation service through your Medical Scheme which will be based on your policy rules.

Insurers

  • Price on review of volume and data integrity

We are not attached to any Scheme and as a result Medwyze will give you completely impartial information on your upcoming procedure. Should there still be a short fall on your account, our Clinical and Investigations Team will take over the process to get it resolved.