Treatment plan claims may be short paid or rejected for a number of reasons.
The most common reasons include:
- When you have not registered your chronic condition with the Fund.
- When you elect to make use of a doctor that is not included in your Fund’s list of contracted providers.
- When your claim exceeds the number of scheduled consultations, diagnostic tests or any other service (tariff) as outlined in your treatment plan letter.*
- When you claim for services (tariffs) not included in your treatment plan letter.*
*Your treating doctor may motivate to increase an existing service or motivate to include a service not currently included in your treatment plan.