South African healthcare & funding
If a claim or authorisation is refused, you can ask for written reasons, submit a formal internal dispute with supporting clinical evidence, and if still unresolved lodge a complaint with the Council for Medical Schemes. Keep every letter, reference number and claim statement, and note the deadlines that apply at each stage.
Also known as: dispute, complaint to CMS, internal dispute
Related South Africa guides
Sources
- Council for Medical Schemes (South Africa)
Last reviewed: 8 September 2026. Written by the Antega Editorial Team. General information only — always follow the advice of your own clinic, doctor or pharmacist.