Medical Aid Claims Contact Details

There is no single medical aid claims number. Claims are handled by your own scheme, so the number, email address and portal you need are the ones your scheme publishes, usually on its website and on the back of your membership card. This page explains which route suits which claims problem, what to have in hand, and where to go when the scheme does not fix it.

ContactDetails.co.za is an independent directory, not a medical scheme, and cannot look up or process a claim.

Which route for which problem

• Submitting a claim you paid yourself: the scheme’s app or member portal is usually quickest, and it gives you a reference number straight away. A claims email address is the fallback.
• Checking whether a claim was paid: the portal or app shows claim status and payment dates. Phone the call centre if the status makes no sense.
• A rejected claim or a short payment: ask the call centre for the reason code first. Many rejections come down to a missing practice number or ICD-10 code that your doctor can correct and resubmit.
• Hospital admission: this needs pre-authorisation before the admission, not a claim afterwards. Call the scheme’s authorisation line.
• A claim you did not make: report it to the scheme as possible fraud, and do not pay anyone who contacts you about it.

What to have ready

• Your membership number and the dependant code of the patient
• The main member’s ID or passport number
• The itemised account showing the provider’s practice number, the date of service, tariff codes and ICD-10 codes
• Proof of payment, if you paid the provider and want the money back
• Reference numbers from any earlier calls or emails about the same claim

An account without diagnosis codes is the most common reason a reimbursement is delayed, so check for them before you submit.

If the scheme does not resolve it

• Ask for a written explanation of the rejection or short payment, and note the date, the agent’s name and the reference number of every call.
• Lodge a formal written dispute with the scheme, attaching the account, proof of payment and any motivation from your doctor.
• If the scheme’s internal process is exhausted, complain to the Council for Medical Schemes, the regulator for all medical schemes in South Africa: 086 112 3267 or 012 431 0500.

Scheme contact pages

For a specific scheme, start with Bankmed Contact Details, Bestmed Claims Contact Details or Bestmed Contact Details. The full list of schemes is on the Medical Aid hub, and insurance, retirement and provident fund pages are under Financial Services.