SAMWUMED is committed to fairness, openness, and transparency. The Scheme also promotes the highest level of professional and ethical behaviour.
Members and Providers can use the following methods of communication to lodge complaints or disputes.
SAMWUMED will acknowledge receipt in writing to the Complainant within 24 hours of receiving the Complaint. The Scheme will process and resolve the matter within 30 days following internal process the Complainant will be notified in writing of the findings.
If the Complainant is still dissatisfied after following the above complaints procedure, he/she may request the Principal Officer to refer the complaint to the Dispute Committee.
If the decision of the Dispute Committee is not acceptable to a Complainant, the Complainant may appeal against the decision to the Council for Medical Schemes in terms of Section 48 of the Medical Schemes Act
If a Complainant chooses not to follow the Dispute Resolution Procedure, but to rather lodge a complaint directly with the Registrar of Medical Schemes, the Scheme will submit all the required information to the Registrar.
Any beneficiary or any person who is aggrieved with the conduct of a medical scheme can submit a complaint. It is however very important to note that a prospective complainant should always first seek to resolve complaints through the complaint’s mechanisms in place at the respective medical scheme before approaching the Council for assistance.
The CMS governs the medical schemes industry, which means it can facilitate unresolved complaints about your medical scheme. If your complaint is related to any other aspect of the health industry, please follow the links below: