2024 FIRST CHOICE
27
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
BACK TO CONTENTS PAGE
