Medical Aid Auth Form

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Permission to claim from Medical Aid

Please note: Your Contract for medical aid payment is between yourself and your medical aid.

  • Our company, Two Running Hares Pty Ltd (T/A Mobilityscooters.co.za and SA Scootershop.co.za) can assist you in obtaining authorisation and/or funds from your medical scheme by submitting a quotation and/or an invoice to the relevant party.  We only submit further documentation upon your request.
  • We will require your consent to do so.
  • Once submitted, we will follow up with your medical scheme and give you feedback.  Kindly provide us with contact details of the person who should receive that feedback

We cannot guarantee authorisation or payment from your scheme before your discharge. Each Medical Aid has different policies and payment times, we will do our best to expedite your claim, however certain Medical aids do take longer than others. Due to this, there may be a stock delay as we cannot hold stock until payment has been received. You are welcome to pay upfront and we can then assist in getting a refund for you. We cannot guarantee that the available funds given on enquiry will be covered by your medical aid.  You may have other claims in the system which have not been accounted for which could result in short payment for the equipment. It is your responsibility to settle any shortfall in your account.

We therefore recommend that you also contact your scheme to speed up the process as well as to confirm available funds.

  • PAYMENT OF THE ACCOUNT WILL ULTIMATELY REMAIN YOUR RESPONSIBILITY. We cannot be held accountable for non or short payment from your scheme even if your medical aid has authorized a specific amount. 
  • Kindly notify us of any feedback you may receive from your funder. In all likelihood, they may advise the member before Us (Two Running Hares Pty Ltd (T/A Mobilityscooters.co.za), of authorization or payment.
  • Should the medical aid make payment to the member and the equipment is not taken, the claim will be reversed with the medical aid and the funds would have to be paid back to your medical aid.  
  • Please be advised that some medical schemes will use your savings to cover claims before you go through self payment gap and then onto above threshold. 
  • Funds paid to the member must be paid over within 7 days of your receiving the funds. Failure to do so will result in claims being reversed and member will be responsible for any outstanding debt to your medical aid.
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Max. file size: 64 MB.
To complete your application, please upload here, or email to sales@mobilityscooters.co.za