Medical Aid Complaints – Submit
Anyone can submit an account related complaint against a medical aid in the Republic of South Africa. Medi-COP will investigate your complaints against medical aids. Submit your complaint where the medical aid refuses to make payment in full or any payment, as well as paying your claims incorrectly from your ‘savings plan’ (day-to-day expenses) and we will advise you accordingly.
If Medi-COP is of the opinion that there was any wrongdoing, we will correspond with the medical aid to correct it. In such a case the complainant will be informed to make payment for the service – see cost for different Medi-COP membership and non-members. If Medi-COP is of the opinion that there was no wrongdoing from the medical aid, we will inform you accordingly and there will be no cost involved.
If the medical aid still refuses to correct it, we will proceed to publish such a case on our website (without identifying the complainant) for public view, as well as making use of other social media services and Medi-COP’s Facebook page. In case where the publishing of the complaint on www.medi-cop.co.za or through other social media, or further pressure by Medi-COP, results in the medical aid correcting the situation, the cost for service will be equivalent to 20% of the fees recovered, minus any initial fees paid. In such a case, the complaint will stay on the website for 6 months. If not corrected, it will remain published for 2 years on the website.
Medical Service Providers Complaints (like medical professionals & hospitals) – Submit
Anyone can submit a complaint about sub-standard care or lack of care, poor service and negligence by a medical service provider in Gauteng (this facility will be extended to other provinces in the near future). Medi-COP will provide feedback to the complainant about the complaint submitted and where necessary, bring it to the attention of the service provider to give them the opportunity to investigate internally and correct it, as well as take any internal disciplinary / corrective action where necessary. Medi-COP will also advise the complainant, based on the information available at the time, on options for further action where necessary. Alternatively where a complaint of negligence is of a serious nature, Medi-COP will advise the complainant that it may require further investigation.
For Medi-COP to be able to assist with further investigation of the matter, it may be necessary for a non-member of Medi-COP to register as a Core Medi-COP Member or Premium Medi-COP Member. The purpose of such an investigation is to peruse the records and give the complainant a preliminary opinion as to whether he/she should to seek legal representation to potentially take the matter further. Such an investigation will cost R3450.00 (incl.VAT) plus the cost of copying the files.