In August 2010 My wife to be at that stage, receive medical treatment at certain south african hospital. the treatment she received in Hospital was contracted to an outside company. Since all these treatments received was received in hospital we assumend all hospitilisation was covered by the bill send by the hospital. On the 9th of April 2013, my wife received an sms from a medical bills and collections company that she needed to call them regarding an outstanding account.
During the period from August 2010 to 9 April 2013 she did not receive any form of communication from the service provider that the account was still outstanding. She never received any invoice or telephone call although her contact details stayed unchanged. When she returned the call she was informed that the treatment she received in August 2010 was not paid and that she need to arrange for payments. We were shocked and she replied that she was never contacted once in nearly three years. The company claimed that they did phone and posted invoices which we never received. On 10 April 2013, my wife phoned the medical aid to enquiry why the claim was never paid. The medical aid confirmed that claim was only received September 2012 (two years after service was received). The medical aid rejected the claim. The medical aid also confirmed that if they received the claim on time they would have probably paid.
Now I want to enquire what I need to do and what steps I need to follow. May I refuse to pay the outstanding account? Or am I still liable for account although the service provider obviously was negligent in sending the claim to the medical aid on time?
The following is an frequently asked question on the website of the counsel of medical schemes
CLAIMS, PAYMENT OF ACCOUNTS AND MEDICAL SAVINGS ACCOUNT (MSA)
Q43. Within what period of time must my account for services or claim reach my medical scheme?
The account must be submitted not later than the last day of the fourth month following the month in which the service was rendered.