Treatment plan claims may be short paid or rejected for a number of reasons.

The most common reasons include:

1. When you have not registered your chronic condition with the Fund.
2. When you elect to make use of a doctor that is not included in your Fund’s list of contracted providers.
3. When your claim exceeds the number of scheduled consultations, diagnostic tests or any other service (tariff) as outlined in your treatment plan letter.*
4. 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.