Submitting a Claim

Submitting a claim means sending your medical account to the scheme so it can pay the provider directly or reimburse you if you have already paid. Sometimes the doctor or hospital sends the claim for you. Sometimes you need to submit it yourself through an app, website, email, WhatsApp service, or member portal, depending on the scheme.

A claim is not just a receipt with good intentions. To be processed properly, it usually needs specific information. Scheme guidance commonly includes your membership number, the principal member’s details, the patient’s details, date of treatment, amount charged, diagnosis code, tariff or procedure code, provider name and practice number, and proof of payment if you paid out of pocket.

The good news is that schemes increasingly offer digital ways to submit and track claims. The less good news is that missing information can still delay payment. So the process is simple, but it does need accuracy. In healthcare administration, “close enough” is not really a category.

Best practice for claims:

• Check whether the provider will submit the claim for you
• If not, use your scheme’s approved channels such as the app, website, email, or portal
• Include all required details, especially membership number, treatment date, codes, and provider details
• Keep proof of payment if you paid first
• A complete claim is usually processed faster than a mysterious one with half the story missing

A Universal Cover broker can also help clients understand the claims process, which forms part of practical financial advice and ongoing support after joining a scheme.