Funding Support
Our commitment to funding:
orthotics & prosthetics made accessible
At Bradley Beckerleg we understand that high-quality prosthetic and orthotic care is only effective when patients can access and afford it.
What each funding source is and how they differ
We are experienced in pursuing reimbursement across all South African funding routes. including Prescribed Minimum Benefits (PMBs) through medical schemes, private funder pre-authorisations and normal claims, ex-gratia requests, the Road Accident Fund (RAF) and compensation under the Compensation for Occupational Injuries & Diseases Act (COIDA).
We work with you at every step to prepare robust clinical motivation, complete the required paperwork, liaise with payers, and protect your rights as a patient.
1) Prescribed Minimum Benefits (PMBs)
Medical schemes must pay for defined conditions
PMBs are set by the Medical Schemes Act and require medical schemes to fund specified minimum treatment for certain defined conditions and healthcare events. For many prosthetic/orthotic needs that arise from listed PMB conditions (for example, most amputations or chronic conditions leading to prosthetic need), a PMB application can unlock full or partial funding irrespective of the member’s plan option — provided the condition and clinical need meet PMB rules. We help prepare and submit the PMB application and supporting clinical evidence.
2) Private medical scheme (normal claims / pre-authorisation)
Private funders pay according to the scheme rules and benefit limits in the member’s plan. Many prosthetic/orthotic items require prior authorisation/pre-approval and will be paid out of the scheme’s prosthetic/medical appliance benefits. If a scheme admits liability, the claim is paid under normal rules; if it refuses all or part, alternative routes (PMB, ex-gratia, or legal remedies) may be pursued. Provider guides and scheme PMB instructions explain the pre-auth and claims process — and we’ll complete pre-auth submissions for you.
3) Ex-gratia (compassionate) payments
Ex-gratia payments are discretionary, once-off contributions a medical scheme may make beyond registered benefit limits for compassionate or exceptional clinical reasons. These are not guaranteed or enforceable like PMBs, but with a strong clinical motivation and cost breakdown we will submit an ex-gratia request on your behalf when appropriate.
4) Road Accident Fund (RAF)
RAF covers injury, medical and rehabilitation costs arising from road accidents caused by the negligence of another road user. RAF claims follow statutory forms and evidence requirements (RAF1, medical reports, police reports, invoices and supplier quotations). If the RAF accepts the claim, prosthetic clinics can be paid directly following pre-authorisation and submission of formal quotes and acceptance documents. We prepare the clinical proposals, quotations and delivery documentation that RAF requires.
5) COIDA / Compensation Fund (workplace injuries)
COIDA provides compensation for workplace injuries and related medical care. If an injury is accepted as an occupational claim, the Compensation Fund pays reasonable medical expenses and rehabilitation (including prosthetics/orthotics) under COIDA processes and tariffs. Employers, employees and medical providers must follow strict notification and claim lodgement procedures; we will assist you with the clinical reporting and required documentation.
Frequently Asked Questions
If my scheme refuses, do I have options?
Yes. Options include internal appeal, PMB review (if your condition qualifies), ex-gratia application, or external complaint to the Council for Medical Schemes. We’ll prepare the clinical package and guide you through each route.
Do I have to pay upfront?
What is the difference between PMB and normal benefits?
How do I know if my condition qualifies as a PMB?
My scheme said I don’t have any prosthetic benefits left. Can I still get funding?
Yes — you may still qualify for PMB funding (if your condition meets PMB criteria) or for an ex-gratia (compassionate) payment. We’ll prepare the motivation and submit it for you.
What is an ex-gratia request?
It’s a discretionary payment a medical scheme may make when normal benefits or PMBs do not cover your device. It is not guaranteed, but a well-motivated application can succeed.
Do I have to use a designated service provider (DSP)?
For PMB treatment, schemes may appoint DSPs. If you voluntarily go elsewhere, you could face a co-payment. We can help you check DSP status and request exceptions if necessary.
What documents are always needed for funding applications?
Typically: your ID, medical scheme membership details, a clinical motivation letter, medical/surgical reports, and our detailed quotation. Some funders need additional statutory forms (RAF1, COIDA claim forms).
How long do applications take?
Medical scheme pre-authorisations usually take a few days to a few weeks if the application is complete. RAF and COIDA processes can take longer because they involve liability decisions and government processes.
How long do applications take?
Medical scheme pre-authorisations usually take a few days to a few weeks if the application is complete. RAF and COIDA processes can take longer because they involve liability decisions and government processes.
Can my employer’s workmen’s compensation cover me?
Yes, if your injury is accepted under COIDA. Your employer must report the injury and you must have a claim number. We’ll then submit medical reports and quotations to the Compensation Fund.
Can I appeal if my claim is rejected?
Yes. Medical schemes must have an internal appeal process, and you may also lodge a complaint with the Council for Medical Schemes. We’ll provide the clinical evidence needed for appeals.
Will I have to pay anything out-of-pocket?
We try to secure full pre-authorisation or direct payment. Some schemes may still apply co-payments or limits. We’ll always tell you about possible shortfalls before you commit.
Does the Road Accident Fund pay directly for prosthetics?
Yes, but usually only after liability and claim acceptance. We can submit quotations and acceptance documents to enable direct payment, but legal processes may affect timing.
What if my injury is both work-related and from a road accident?
Sometimes more than one funding route applies. We’ll advise which claim to pursue first, and how to coordinate benefits between RAF and COIDA.
What is a “delivery and acceptance” form and why do I sign it?
Funders such as RAF and COIDA require confirmation that you received the device. This is used to release payment to the provider. We’ll explain before you sign.
Can I choose a more advanced device than the funder approves?
Yes — you may “co-fund” or “upgrade” by paying the difference. We’ll give you both the funder-approved quote and the upgrade option so you can decide.
Where can I learn more about my rights?
The Council for Medical Schemes website explains PMBs and complaint procedures. RAF and the Compensation Fund also have official guidance. We can point you to the relevant resources and help you with forms.
Next steps
We’ll handle the paperwork with you!
Complete the form below and we will contact you for assistance.