Patient Advocacy: One of the unique benefits you enjoy as an AMS member

We understand that navigating the complex landscape of healthcare can be challenging. While a simple GP visit should be straight forward, we recognise that some of our members with more complicated health care needs may face disadvantages due to a lack of clinical and medical scheme knowledge. To address this, the Scheme supports you with our unique Patient Advocacy assistance, a proactive initiative designed to empower and support you through every step of your healthcare needs.

What is Patient Advocacy?

Patient Advocacy is a comprehensive approach guiding how we assist you. Our patient advocacy team, comprising Administration and Managed Care Staff, act as the voice, or advocates for our members.

Some of the examples how we can assist you as patient advocates in your health journey

Communication facilitation:

• We assist you with effective communication between you and your healthcare providers.
• Our patient advocates help you in understanding medical procedures, available options, and cost implications.

Benefit optimisation:

• Before any procedure, we optimise benefits based on your individual assessment, by providing clarity on the cost and possible co-payments for your procedure and assist you in understanding your procedures. This will empower you to negotiate with your provider.
• When transitioning between medical facilities, particularly when moving to sub-acute, frail care, or other facilities, we guide you to ensure a smooth process and utlisation of the correct benefits.

Medicine management:

• We advise you on how to reduce out-of-pocket expenses by changing medications.
• We consider co-payment override requests in special cases, as well as advanced supplies.
• We refer cases for independent review if needed.

Disease and/or case management:

• We help you understand how important it is to comply with your treatment and what happens if you don't.
• If you have certain clinical needs for specific conditions, we can consider PMB treatment basket extensions.
• We provide you with case management and support whilst in hospital.

Dedicated service and support:

• We provide you with a dedicated Client Liaison Officer for personalised assistance at employer sites.
• We offer dedicated and AMS specialised services in most of our administrator servicing areas ensuring that you have access to someone that is well versed in AMS benefits and support.
• We manage difficult cases and exceptions with service providers like Netcare 911, The Centre for Diabetes and Endocrinology (CDE), Prime Cure, Dis-Chem, and the Dental Risk Company (DRC).

Retrospective reviews:

• We recognise that in time of need, for example, for a hospital admission or a treatment, obtaining authorisation might not be top of mind, even though it is a requirement to access certain benefits.
• As a member you can ask us for a retrospective review of your event and the team will assess your case while still applying all rules and benefit structures.

Ex Gratia consideration:

• The Ex Gratia Committee considers cases where a member cannot afford valid healthcare services and will assess each case on its own merits.

Your well-being, our priority

AMS is committed to ensuring that you, our members, not only have access to quality healthcare but also receive the support you need throughout your medical needs. Patient Advocacy reflects our dedication to being your partner in health, advocating for your best interests every step of the way. If you have any questions or concerns, feel free to reach out to us on 0860 222 633.

Published March 2024