Medical scheme follow-up.
Unresolved revenue can disappear into silence when queries are not systematically tracked. Follow-up is the whole job.
Claims are rarely lost to a firm no. They are lost to nothing at all: a query raised once, never answered, never chased, and quietly forgotten by both sides.
Start every query with a reference
A query without a reference number effectively did not happen. It cannot be picked up by a different agent, it cannot be escalated, and it cannot be evidenced later. Getting the reference is the single highest-value thing to do on any call.
Write down more than the outcome
- The date and time of the contact
- The name of the person and their department
- What they undertook to do, in their words
- The date by which they said it would happen
Escalate along the scheme's own path
Schemes have internal escalation routes. Using them, in order, with references attached, works better than repeating the same first-line call and hoping for a different agent.
This article is general information about healthcare administration in South Africa. It is not legal, clinical or financial advice, and it does not describe the rules of any particular medical scheme. Always check the position that applies to a specific claim.