Co-Payment Claim Optimiser
Medical schemes have co-payments or upfront payments that apply to certain procedures or tests (eg MRI/CT scans) that must be paid by members before undergoing the treatment or tests.
To assist Cinagi members, we have established the Co-Payment Claim Optimiser, where we will guarantee the payment directly with the relevant facility prior to you having the procedure/treatment. This means that you do not need to make any out-of-pocket payments and we will pay the provider directly on your behalf.
Please note that this service is not available if your policy is still subject to a waiting period – kindly read the ‘Important Notes’ below on how and when the Co-Payment Claims Optimiser service can be utilised.
How does it work?
- Obtain the pre-authorisation letter sent to you from your medical scheme.
- Complete this form at least 72 hours before your admission by clicking on the ‘Next’ button at the bottom of this page.
- Fill in the details on the form and upload the above pre-authorisation letter when requested.
- Once your request has been reviewed and approved by us, we will provide a payment guarantee to the facility.
- You will receive a confirmation letter from us which can be presented to the provider on the day of admission/treatment.
- The Co-Payment Claim Optimiser is not available if your cover is still within a waiting period.
- This facility is only applicable to defined co-payments or upfront payments (as per your medical scheme rules) and that are covered in full by your Cinagi Gap Cover policy. Examples are:
- Radiology (eg, MRI and CT scans)
- Scopes (eg, gastroscopy, colonoscopy, sigmoidoscopy, proctoscopy, etc)
- Wisdom teeth extraction
- Defined Co-payments on specified surgical procedures
- Any additional shortfalls that arise after your procedure/treatment that are not covered by the Co-Payment Optimiser, will require you to submit a separate claim, you can intiate the claim HERE.
- By making use of this service you agree to cede to us the benefits relating to co-payments under your Cinagi Policy for this procedure. This only applies to co-payments or upfront payments that have been approved by Cinagi.