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: [email protected]
Dental claims go to DENIS instead: [email protected], tel 0860 104 926, fax 0860 677 0336
Client Service Centre for claim queries: 0860 671 050, [email protected], 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, [email protected]
Oncology management programme: 0860 671 060, [email protected]
Disease Risk Management Programme: 0860 671 060, [email protected]
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. [email protected] 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 [email protected].