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First and foremost, educate
yourself about your medical scheme’s rules, the listed medication and
treatments (formularies) for your specific condition, as well
as who the Designated Service Providers (DSPs) are. |
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Obtain as much information as possible about your condition
and the medication and treatments for it. If there is a generic
drug available, do your own research to find out whether
there are any differences between it and the branded drug. |
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Don’t bypass the system: if you must use a GP to
refer you to a specialist, then do so. Make use of your medical
scheme’s DSPs as far as possible. Stick with your scheme’s
listed drug for your medication unless it is proven to
be ineffective. |
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Be a good consumer: ask questions and follow
the complaints process if you are not treated fairly. |
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Make sure your doctor submits a complete account to the
medical scheme. It is especially important that the correct ICD-10
code is reflected. |
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Follow up and check that your account is submitted within
four months and paid within 30 days after the claim was received
(accounts older than four months are not paid by medical
schemes). |
