Claims

At Med-Sure Services, medical benefits administration is our business. From enrolment assistance to expert claims administration, no other benefits administrator does more to help your health care benefit money go further.

Med-Sure uses in-house-developed administration software and systems to manage self-funded health benefit programmes, in addition to other benefit plans. With customer service professionals at hand, comprehensive reporting capabilities, our clients, members and providers get the help and information needed to make timely, informed decisions.

Many companies seem content to sit by passively as the costs of their employee benefits plans continue to rise unabated. In our view there is a very real difference between mere claims processing and effective group health plan administration. Some insurers relegate claims processing to a mere transactional function with little or no analysis or management reporting.

Insurers often take the path of least resistance in relation to “small” claims. Take, for example, the following common ailments:

  • Diarrhea
  • Sore throat (pharyngitis)
  • Common Cold
  • Bronchitis

In the vast majority of circumstances these conditions do not require a visit to the doctor as they are either self-limiting or can be treated at home with over the counter medicines such as paracetamol, aspirin or ibuprofen.

Moreover, education is required to explain why, by getting admitted to a hospital they are potentially exposing themselves to health risks that pose a far greater risk to their health than any of the conditions mentioned above.

We provide regular management reports to ensure costs can be carefully monitored:

  • Top OPD conditions
  • Top claimants
  • Hospitals
  • Costs

Med-Sure Services know that dealing with healthcare issues can be stressful for employees and their families. That’s why we have friendly and supportive people answering calls. Our bilingual customer service representatives are dedicated to each client. That means representatives are knowledgeable about your individual health plan, and can give accurate, timely, and personalized information. We track performance standards, and quarterly reports are always available to our clients.