In this episode of My Money, My Lifestyle, host Maya Fisher-French shares a personal story that highlights the often-overlooked complexities of medical aid claims, particularly in emergency situations. 

When her 85-year-old mother experienced alarming symptoms and sought treatment at an emergency room, she was left with bills not paid by the medical scheme. 

Maya invites David Green from Med ClaimAssist to discuss what to do when your medical scheme does not cover the cost of emergency treatment. 

They explore the nuances of prescribed minimum benefits (PMBs) and the importance of proper referrals when navigating emergency care. David sheds light on the misconceptions surrounding hospital plans and the potential financial implications of emergency room visits.

Key topics covered include:

• Understanding the limitations of medical schemes regarding emergency room visits

• The significance of referrals from healthcare professionals 

• Strategies for challenging denied claims and navigating the claims process

• The potential for negotiating medical bills and seeking discounts from providers

• Insights into the role of clinical committees in reviewing complex cases

Listeners will gain valuable insights into their rights as medical scheme members and practical steps to take when faced with unexpected medical expenses.