Your medical aid may owe you money. We get it back.
Rejected claims, PMB underpayments and co-payments you should never have paid — MedAssist reviews your medical scheme account and recovers what's rightfully yours. You only pay if we win.
Free claim review
Tell us a little and we'll check whether you're owed money.
Built by insiders, driven by fairness
MedAssist Claims exists for one reason: medical scheme members lose money they're legally owed, and most never get it back on their own. We change that.
Who we are
We're a South African medical claims recovery and advisory company founded by professionals who spent years inside the scheme-administration world — in clinical quality assurance and audit. We've seen, from the inside, exactly how claims are assessed, coded and paid, and where members quietly lose out.
We put that knowledge to work for the member. Our model is simple and fair: a free review to start, and a fee only on money we actually recover. If we don't win, you don't pay.
How we work — our business approach
We are disciplined, evidence-led and compliant by design. Every case is built on the facts, the scheme rules and the law, documented and tracked from intake to recovery. We operate under clear mandates and POPIA consent, we communicate plainly, and we measure ourselves on outcomes — money returned to members, and cases resolved within a fair turnaround.
Your interests come first, always. We advocate; we don't just administer.
Clinical and audit depth on every claim — we read it the way the assessor did.
Honest advice, even when the answer is no. We never overpromise an outcome.
Your personal and health information is protected and processed only with your consent.
Clear fees, clear progress, clear communication — no surprises, no jargon.
We pursue what's owed, all the way to the Council for Medical Schemes if needed.
We know how schemes think — because we've worked inside them
MedAssist is run by clinical and quality-audit professionals who know exactly how schemes assess, code and pay. That's how we know where your money went.
Where members lose money — and we recover it
If your scheme got it wrong, there's often money to be returned. These are the areas we pursue.
Unpaid & rejected claims
Valid claims declined, coded incorrectly or only part-paid — reviewed, corrected and resubmitted for payment.
PMB access & disputes
Prescribed Minimum Benefit conditions must be funded in full. We challenge schemes that wrongly apply limits, savings or co-payments.
MSA corrections
Claims paid from your medical savings account that the scheme should have funded itself — identified and reversed.
Statement audit
A line-by-line review of your claims history to find money you're owed that you may never have noticed.
For medical professionals
Practices and providers: we pursue outstanding scheme payments and short-paid accounts on your behalf.
CMS complaints & appeals
Where a scheme won't budge, we lodge and escalate formal disputes to the Council for Medical Schemes.
Four simple steps
From first contact to money back in your pocket — we handle the paperwork and the scheme.
Free consultation
Send us your statements. We review your claims history at no cost and tell you if there's a case.
Sign & send documents
You sign a simple mandate and POPIA consent so we can act for you with your scheme.
We dispute & fight
We build the case and take it up with the scheme, its administrator and, if needed, the CMS.
You recover, we invoice
The money comes back to you. We invoice our 15% fee only on what's actually recovered.
An example of the work
We're newly launched, so here's an illustrative example of the kind of case we take on. Real, consented client stories will replace it as we win them.
A co-payment that should never have been charged
A member with a chronic PMB condition was repeatedly charged co-payments and told their savings were depleted — paying roughly R18 400 out of pocket over several months.
We reviewed the statements, showed the charges related to a condition the scheme must fund in full, and lodged a motivation citing the PMB regulations. The scheme reversed the charges and refunded the member within six weeks.
Illustrative example created to show the kind of recovery we pursue. Not based on a specific client; figures are representative only and outcomes are never guaranteed.
Authorise us to act with your scheme
Choose your medical scheme to view and download its third-party authorisation. Sign it and send it back with your statements — we'll take it from there.
Your scheme's consent form will appear here, ready to view or download.
The law is on your side
Flip through a short guide to the legislation that protects medical scheme members in South Africa.
Know Your
Rights
A medical scheme member's guide to the money you're owed — and the law that protects you.
The Medical Schemes Act
This is the rulebook every registered medical scheme in South Africa must follow. It sets out how schemes operate, how they must assess and pay claims, and how they must treat their members.
Prescribed Minimum Benefits (PMBs)
PMBs are a defined set of conditions — emergencies, a long list of serious conditions, and common chronic illnesses — that every scheme must fund in full.
This is true regardless of your plan, and regardless of whether your medical savings are finished.
Co-payments & shortfalls
Not every co-payment is valid. Co-payments charged on PMB treatment — or when you used the scheme's designated service provider — are often applied in error.
The Council for Medical Schemes
The CMS is the independent body that regulates all medical schemes and adjudicates complaints from members.
More than half of the members who formally escalate a dispute receive a ruling in their favour.
Protection of Personal Information (POPIA)
POPIA governs how your personal and health information is collected, stored and used. It requires your consent, and gives you the right to access, correct and object.
The National Health Act
This Act sets out your right to health services and your right to access your own health records and information held by providers and schemes.
The CMS complaints procedure
When a scheme will not resolve a complaint, it can be lodged formally with the Council for Medical Schemes, which investigates and issues a binding ruling.
Think you might be owed money?
Common signs: a chronic or PMB claim was rejected; you were told your “savings are finished”; you paid a hospital or specialist co-payment; or you received a clawback demand.
info@medassist.co.za
www.medassist.co.za
Not sure if you're owed? Find out — it's free to ask.
Send us your details and we'll review your claims history at no cost. You only pay if we recover money for you.
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