2024 DOUBLE PLUS & DOUBLE NETWORK
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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 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 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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