28
2023
NETWORK CHOICE
COMPLAINTS & DISPUTES
Who do I contact if I have a query?
The CAMAF Customer Care on 0860 100 545 or email
them on custcare@camaf.co.za
What do I do if I have a dispute with the
scheme?
Members may lodge their complaint in writing to the
scheme. 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 offered by 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
• Not 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.
