Medihelp specialist networks

Why does Medihelp have specialist networks?

Visiting specialists in the network of nominated specialists for PMB services and the contracted network of surgeons with whom tariffs for PMB and non-PMB services have been negotiated can help you to contain out-of-pocket expenses.

Tip: Phone your specialist’s rooms before you make an appointment and enquire about their fees. This will ensure that you know exactly how much you will have to pay from your own pocket, if anything. You can also negotiate a reduced fee with your specialist or arrange payment terms.

How do I find a network specialist?

You can find the lists of all Medihelp’s network providers, hospitals and day clinics on our website at www.medihelp.co.za or download Medihelp’s smartphone app for members (available on Google Play Store and iStore) to find a specialist. You can also phone our Call Centre on 086 0100 678.

How do I make use of network specialists’ services if I am on a network option?

Network benefit options have their own hospital networks and network specialists are matched to these hospitals. Always make sure that the network specialist you select, operates at your network hospital.

How does Medihelp pay specialists?

Medihelp pays your specialists’ accounts for consultations and treatment according to your Medihelp plan’s benefits. Consult your benefit guide for details.

Payment is made in one of the following ways, depending on your specialist’s arrangement with the Scheme:

• The specialist submits a claim to Medihelp and Medihelp pays the specialist. If the specialist’s fee exceeds the scheme tariff, you are liable to pay the balance to the specialist.
• The specialist requests payment upfront from you. You can then submit the account to Medihelp for a refund.
• The specialist submits a claim to Medihelp and Medihelp pays its contribution to you with the instruction that you should settle the account in full with the specialist.