Start by speaking to your scheme. Put all your communication in writing.
Some schemes will have an appointed person who deals with escalated queries or complaints. If your complaint is not resolved to your satisfaction, ask your scheme if the matter can be escalated.
You can also contact the Council of Medical Schemes. This is “a statutory body established by the Medical Schemes Act to provide regulatory supervision of private health financing through medical schemes”.
The Council regulates all schemes, and you can submit a complaint to them at any time. Put all your communication in writing, and ensure that you submit all relevant information, including copies of all correspondence between you and your scheme. You can send this by registered post, or you can email it to firstname.lastname@example.org.
You can also visit the Council of Medical Scheme’s website, or call them on 0861 123 267.
We also encourage you to voice your experience with your scheme on our Forums, including their response as well as the response from Council, if any. Please read our forum guidelines first, to ensure we maintain a useful, fair and dignified presence.