Medical aid claims

Your medical aid details

Add your scheme, plan, membership number, main member and dependant code to your profile. Membership numbers are stored encrypted. Keeping these details current helps avoid rejected claims.

How claims work

After your consultation, the practice prepares a claim from your invoice, with the procedure (tariff) codes and diagnosis (ICD-10) codes your scheme requires. The practice then submits the claim to your scheme.

At present, practices submit claims through their own channels. Maatla Care does not yet send claims to medical schemes electronically.

What you might pay

Whether your scheme pays in full depends on your plan, your available benefits and the practice's fees. You may need to pay a co-payment or a shortfall. Some practices ask patients to pay upfront and claim back from their scheme.

Diagnosis codes

Medical schemes in South Africa require diagnosis codes on claims, so your scheme will see the codes on your claim. If you have questions about this, speak to your doctor.

Who to ask

For the status of a claim, ask the practice. For questions about your benefits or what your plan covers, ask your medical scheme.