How to make a claim for treatment under a direct billing facility

Where direct billing arrangements are in place:

a)    Check that your treatment is covered under the plan – if you are unsure, contact us.

b)    Visit the treatment providers on the list for out-patient treatment.

c)     Show your membership card.

d)     The treatment provider will then deal with your claim administration. Receive your treatment.

e)     You must pay any excess or co-insurance that applies to your plan. This excess or co-insurance will be shown on your membership card.

If after we have paid a claim, it is subsequently found to be ineligible under the terms and conditions of the plan, we have the right to recover the payment from you or the planholder. Payment of any such claim is not an indication of our acceptance of liability for the claim or confirmation that further costs for treatment for the same or any related medical condition(s) will be met. If we refuse to pay a direct billing claim under the terms and conditions of the plan, you will have to pay the cost of the claim within the period specified by the treatment provider upon receiving notice from them.