AI-powered medical aid appeals
Your medical aid said no. Appeal it.
Upload the rejection and statement. ClaimRight checks the rules, drafts a cited appeal and helps escalate unresolved cases to the Council for Medical Schemes.
Free assessment · Flat fee if accepted · No success fee
The ClaimRight path
Evidence → rules → appeal → escalation
What to expect
A fair fight, without false promises.
A free assessment before any appeal fee
Citations drawn from a curated rules corpus
Human quality control on outbound appeals
Clear refusal of claims outside our scope
From rejection to response
One case file. Four deliberate steps.
ClaimRight is built for specific, potentially wrongful payment decisions—not every disappointing medical bill.
Best-fit cases
PMB denials or caps, emergency claims, CDL medicine refusals, technical rejections and claims unpaid beyond the expected response period.
- 1
Upload the evidence
Send your rejection letter, claim statement, scheme and plan details through a guided, consent-based intake.
- 2
Find the rule breach
ClaimRight checks PMB rules, chronic disease protections, emergency requirements and your scheme’s registered rules.
- 3
Build the appeal
Your appeal is drafted with relevant provisions and supporting sources, then quality-checked before submission.
- 4
Track and escalate
We track the response window and prepare a Council for Medical Schemes complaint pack when escalation is appropriate.
Transparent, once-off pricing
Know the fee before the fight starts.
No monthly subscription and no percentage of recovered funds. We assess first, then recommend the right appeal package.
Assessment
Free
A scope and eligibility check before you commit.
- Document review
- Claim-type classification
- Clear accept or decline
Standard appeal
R490once-off
For accepted PMB, chronic, emergency and technical-rejection cases. Planned standard price after launch: R990.
- Rules-based appeal draft
- Human quality check
- Submission-ready evidence pack
- Deadline tracking and escalation support
Hospital account
R1,490once-off
For complex hospital statements involving multiple line items, providers or denial reasons.
- Detailed account analysis
- Multiple denial reasons
- Consolidated appeal pack
- Escalation preparation
Refund promise: if ClaimRight accepts your case but does not produce and submit the agreed appeal, your appeal fee is returned. Outcomes remain subject to the scheme and regulator.
Straight answers
Before you upload anything
Turn “declined” into a case
Don’t leave a wrongful denial unanswered.
Upload the rejection letter and statement. We’ll assess whether the claim fits ClaimRight’s scope before you pay.