What happens with a non disclosure investigation and when does it happen?
This happens when a new member is being admitted into hospital, and the hospital needs to get an authorisation number.
The meaning of a non disclosure investigation from all medical aid schemes, is that when a member joined a new medical aid and have been on the medical aid for less than a year and get admitted into hospital, the medical aid have the right to do a non disclosure investigation on that patient.
This means that if that member, who has been admitted into hospital, didn’t disclose the condition being admitted for on the medical aid application, the medical advisors from the scheme will do an investigation. This is mostly for existing conditions, for example, diabetes, high blood pressure or hyperlipidaemia.
The doctors from the medical scheme will fax a non disclosure form to the patient’s doctor, requesting a year’s clinical history regarding treatment received for that specific condition (that the member has been admitted for).
The information must be provided to the scheme in the next 24 -48 hours to be processed and finalised. If it is found that the patient did received treatment in the last year for that specific condition he has been admitted for, and didn’t mentioned it on the application the scheme has the right to terminate that whole new application. The scheme can also impose a 12 month specific condition waiting period or an exclusion.
The application may be terminated immediately and the member will have to re-apply again.
This will be the members decision to join the same medical aid scheme again or a different medical scheme.
CareLine Group will take the time to assist any new joiners to Medical Aid Schemes. Contact CareLine Group on 0861 45 00 45 or compete our Contact Us form and we will get back to you.