SAMWUMED is committed to paying member claims as speedily as possible. To enable this, members must submit all the required information to allow for the processing of the claim.
The Scheme needs an Account Statement not older than four months reflecting:
- Surname and initials of the Member or patient
- Membership number of the Member
- The practice code number of the service provider or doctor
- The date on which each relevant health service was done
- The cost of the services
Non-Payment of Claims
Where claims are not paid, reasons would include the following:
- Where the Scheme believes that the claim is not correct
- Where the Scheme suspects fraud
- Where required authorisations were not given by the Scheme before the treatment
Where claims are rejected, the Scheme will communicate with the member within 30 days
The member will have 60 days to correct the claim and resubmit to SAMWUMED
Member reimbursement
Where a member paid for treatment and claims from the Scheme, the claim must be supported by an original receipt.
