KeyHealth Claims Contact Details

Before anything else, check the address you are on. KeyHealth’s website is keyhealthmedical.co.za. The shorter keyhealth.co.za is a domain-for-sale parking page, not the scheme. Members who type the obvious address land on a page that anyone could buy, so make sure the domain has medical in it before you send documents or click a link.

Submitting a claim

• Claims submission, excluding dental: general@keyhealthmedical.co.za
• Dental claims go to DENIS instead: claims@denis.co.za, tel 0860 104 926, fax 0860 677 0336
• Client Service Centre for claim queries: 0860 671 050, info@keyhealthmedical.co.za, WhatsApp 060 976 8319
• Hours: Monday to Friday, 07:30 to 18:00, excluding public holidays

Note the split. Dental claims are administered by DENIS on its own address and its own fax, and sending a dental claim to the general address adds a hop. Everything else goes to general@.

Authorisation is a different number from claims

• Hospital pre-authorisation: 0860 671 060, preauth@keyhealthmedical.co.za
• Oncology management programme: 0860 671 060, oncology@keyhealthmedical.co.za
• Disease Risk Management Programme: 0860 671 060, disease.management@keyhealthmedical.co.za
• Chronic medication registration, for providers: 0800 132 345

An unauthorised admission is the most common reason a large hospital claim is short-paid. Get the authorisation number before the procedure where the admission is planned, and quote it on the claim.

Walk-in offices, and which ones have a phone

Open Monday to Friday, 07:30 to 15:30, public holidays excluded. Note the earlier closing time than the call centre.

• Centurion — PPS Centurion Square, corner Gordon Hood and Heuwel Roads
• Gqeberha — 170 Cape Road, Mill Park. 041 373 0020
• Cape Town — 28A Wale Street. No office telephone number published
• Polokwane — 41 Hans van Rensburg Street. No office telephone number published
• Durban — 236 on Ninth Avenue, Windermere Centre. No office telephone number published

Only Gqeberha has a published direct line. KeyHealth says so itself for the other four, so use 0860 671 050 for those and go in only for something that needs a counter.

Postal address

KeyHealth Medical Scheme, PO Box 14145, Lyttelton, 0140.

Getting a claim paid first time

• The account must show the practice number, the ICD-10 code and the tariff code. A handwritten receipt without these will reject.
• Submit within the scheme’s stale-claim period. Claims submitted late are not paid, and that period is short.
• Keep proof of submission. proofofpayment@keyhealthmedical.co.za is the address for payment proofs on membership matters.
• If a claim is short-paid, ask for the reason code in writing before you argue.

If a claim is rejected

• Use KeyHealth’s published complaints process first and keep the reference.
• A Prescribed Minimum Benefit condition must be paid in full regardless of your option or savings. If that is what was refused, say the words “PMB” in the complaint.
• Unresolved, it goes to the Council for Medical Schemes, the statutory regulator, free of charge.
• Suspected fraud, by a provider or anyone else, goes to the ethics line on 087 023 0161 or fraud@keyhealthmedical.co.za.