Name of the Organization : LA Health
Type of Facility : How to claim LA Health Medical Scheme
Head Office : Benmore
Website : https://www.lahealth.co.za/portal/
How To Claim LA Health Medical Scheme?
When sending claims to the Scheme, please make sure you do the following :
** Check your personal file with your doctor to ensure all your details are up-to-date
** Check all your details against your membership card, especially your membership number.
Related : LA Health Medical Scheme Application : www.southafricain.com/4674.html
** Ask if your doctor charges the Scheme Rate or a higher rate and negotiate with him or her to charge at the Scheme Rate
** If your doctor sends the claim to the Scheme electronically, you do not need to send a copy to us
** If you send your claim to the Scheme, please send the original copy with your correct membership number
** Send us a detailed claim and not just a receipt. We need the details so we can process your claim
** Make sure your membership number, doctor’s details and practice number are clearly visible on the claim.
By law, each claim must contain the following information :
** The surname and initials of the member
** The surname, first name and other initials, if any, of the patient
** The name of the medical scheme concerned
** The membership number of the member
** The practice code, group practice and individual provider registration numbers issued by the registering authorities for providers, if applicable, of the supplier of service and, in the case of a group practice, the name of the practitioner who provided the service
** The relevant diagnostic and such other item code numbers that relate to such relevant health service
** The date on which each relevant health service was rendered
** The nature and cost of each relevant health service rendered, including the supply of medicine to the member concerned or to a dependant of that member; and the name, quantity and dosage of and net amount payable by the member in respect of the medicine
Choose from several ways to send claims :
There are various ways of sending claims to the Scheme for processing :
** Send your claim electronically – by email to claims AT discovery.co.za, or fax to 0860 329 252.
** Drop off your claim at Discovery Health’s offices or at any other assigned Discovery Health claims box.
** You can find these boxes at Virgin Active or Planet Fitness gyms, Dis-Chem pharmacies or at most private hospitals.
** Post your claim to the Scheme.
FAQ On LA Health Medical Scheme
Frequently Asked Questions FAQ On LA Health Medical Scheme
What happens after you send your claim :
** Once we receive your claim, we scan and capture it on our system. We will then assess the claim and make sure all the information on the claim matches the information we have on record for the patient.
** It is then approved or declined for payment. Once we have made the payment, you will receive your claims statement detailing all the claims payments.
How to check on the status of your claim :
** To see the status of your claim, you can access the Claims Search tool or check your claim statement. Alternately you can contact the call centre on 0860 103 933.
** If we have your email address, you can now receive a claims payment notification, that will provide you with all the information about the latest claims we have processed for you – how it was assessed against your available benefits, how it was paid and what the latest balances are – MSA or others.
** Remember to log in and update your information on the website.
How to report fraudulent activities :
** Fraudulent claims affect not only the Scheme, but also you contributions.
Examples of fraud are :
** belonging to two medical schemes at the same time and claiming more than once for the same claim
** sunglasses being billed as prescription glasses
** allowing your provider to claim for procedures /treatment that was not given
** giving non-registered persons access to benefits through misrepresentation; that is when you give your membership card to you neighbour, who is not a LA Health Medical Scheme member, to undergo treatment under your name.
** Check that all transactions related to your membership are true and correct.
** Report any suspicions you may have immediately, by contacting Discovery’s toll-free on 0800 004 500 or email discovery AT tip-offs.com. All calls or contact will be handled strictly confidential. Any person caught committing fraud will be listed on a register and steps will be taken to recover any money you, or the Scheme, may have lost in the process.
Contact Address :
PO Box 652509
Benmore
2010
Features of LA Health Medical Scheme
LA Health Medical Scheme is a medical aid scheme in South Africa that provides healthcare cover to its members. Some of the key features and functions of LA Health Medical Scheme include:
Membership:
LA Health Medical Scheme is open to individuals, families, and employers who want access to quality healthcare services.
Benefit Options:
The scheme offers a range of benefit options to suit the diverse healthcare needs of its members. These options range from basic hospital plans to comprehensive medical aid plans that cover a wide range of healthcare services.
Healthcare Services:
LA Health Medical Scheme covers a range of healthcare services, including hospitalization, chronic medication, specialist consultations, and preventative care.
Additional Simplified Procedure
There are two ways to claim LA Health Medical Scheme online:
Through the LA Health website:
1. Go to the LA Health website: https://www.lahealth.co.za/.
2. Click on the “Claims” tab.
3. Click on the “Online Claims” button.
4. Enter your member number and password.
5. Enter the details of your claim, such as the date of service, the service provider, and the amount of the claim.
6. Upload any supporting documents, such as copies of your medical receipts or doctor’s notes.
7. Click on the “Submit” button.
Through the LA Health app:
1. Download the LA Health app from the App Store or Google Play.
2. Open the app and sign in to your account.
3. Click on the “Claims” tab.
4. Enter the details of your claim, such as the date of service, the service provider, and the amount of the claim.
5. Upload any supporting documents, such as copies of your medical receipts or doctor’s notes.
6. Click on the “Submit” button.
Here are some additional tips for claiming LA Health Medical Scheme online:
** Make sure you have all of your required documents ready before you start the claim process.
** Read the claim form carefully before you submit it.
** Make sure you upload clear and legible copies of your documents.
** If you have any questions, you can contact LA Health customer service.
Here are some of the benefits of claiming LA Health Medical Scheme online:
** It is convenient and easy to do.
** You can track the status of your claim online.
** You can save time and money by avoiding the need to mail or fax your claim.
Here are some of the risks of claiming LA Health Medical Scheme online:
** You may make a mistake when entering the details of your claim.
** You may not upload clear and legible copies of your documents.
** Your claim may be rejected if you do not provide all of the required information.
Note:
Overall, claiming LA Health Medical Scheme online is a convenient and easy way to submit your claims. However, it is important to be aware of the risks involved and to make sure that you have all of your information ready before you start the claim process.