The Council for Medical Schemes has opened a section to deal with complaints from medical scheme members who find it impossible to get their problems resolved.
Linda Gobela, who heads the section and is a lawyer with a background in consumer affairs, says the Medical Schemes Act allows for a complaints office to assist medical scheme members.
However, before making a complaint to the council, you must first attempt to resolve your difficulties with your scheme and/or its administrators. All schemes are obliged by law to have call centres to resolve members' difficulties.
She says, however, that many schemes do not staff their call centres properly and members can spend hours trying to get their complaints properly addressed. This, in itself, is grounds for complaint to the council.
Gobela says she prefers to receive written complaints which state all the facts and the history of the dispute. Once received, the complaint is referred to the council and the scheme is given 30 days in which to reply. Failure to respond can mean a fine of R1 000 a day for every day that the scheme does not respond.
She says in urgent cases she has been shortening the response period.
The complaints section can be contacted by telephone (012) 431 0500 or fax (012) 431 0560.