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Claims agent for PSEMAS
The claims agent for PSEMAS explains PSEMAS statements line by line and chases missing claim documents.
Ridgeway LogisticsClaims agentWhatsApp
- Customer: Why do I still owe R640 on this?
- Read statement dated 3 OctoberPSEMAS
- Claims agent: Your scheme paid R1,560 of the R2,200 specialist bill, at the scheme’s rate. The R640 left is the specialist charging above that rate. You could ask the rooms if they’ll accept the scheme rate.
- Customer: Can you ask them?
- Claims agent: I can draft the message for you to send, with the claim details. Want it?
What it can do with PSEMAS
- Explains PSEMAS statements line by line and chases missing claim documents
- Match the member to their PSEMAS option from the 2 on file (Standard Option and Higher Option), with their membership number, from a message or a photo of their card
- Answer general questions about PSEMAS cover, and send plan-specific ones to the PSEMAS service line (061 374 150) rather than guess
- Read a claims or benefit statement the member sends and explain each line still owed, in plain words
Questions
What does the claims agent do with PSEMAS?
Explains PSEMAS statements line by line and chases missing claim documents.
Is the PSEMAS connector live?
Yes.
Does the claims agent change claim outcomes?
No.
Does the agent decide PSEMAS claims or authorisations?
No.
Can HR see what staff say to the agent?
No.
Ollie’s agents give wellness guidance. They don’t diagnose or prescribe, and hand off to a human expert when needed.