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VITAL 2021
What do I do if I have a dispute with
the scheme?
Queries are dealt with by the Customer
Care Department. If satisfaction is not
received, there is an escalation process
to be followed within the scheme.
Members may lodge their complaint/s in
writing. You can expect a written reply
within 30 days of receipt of your complaint
/ dispute. If satisfaction is not obtained as
a result of the normal escalation process,
it will be referred by the Principal Officer
to the Disputes Committee, which is
appointed by the Board. A meeting will
be convened by giving not less than 21
days' notice in writing to the scheme
member and the disputes committee
giving the date, time, place and details
of the dispute. A member has the right to
be heard at these proceedings either in
person or through a representative.
What do I do if I am not satisfied with
the service or decisions made by
CAMAF?
There is a complaints procedure to be
followed within the scheme - consult
the website. If you have followed this
complaints procedure and you still
feel aggrieved, you wish to appeal the
outcome of a dispute (see above), or
believe that the scheme has not:
• made an acceptable clinical decision,
• applied the scheme rules correctly,
• contravened the Medical Schemes
Act,
you may contact the Council for Medical
Schemes in writing giving full details of your
case and the reasons for your complaint.
For a complaint form and contact details
go to www.medicalschemes.co.za
or send an email to complaints@
medicalschemes.co.za. The Council
can be contacted telephonically on
012 431 0500 or 086 112 3267.
COMPLAINTS & DISPUTES
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