eQuotes

An eQuote is an invoice (or quotation) which has been submitted to the medical aid and which has been adjudicated by the medical aid to determine what would be covered.  This can then be shown to the patient so that they will know in advance not only what you will charge but also how much will be covered by their medical aid.

eQuotes show the response for each tariff line, including the amount covered and reasons.

Note that eQuotes will not result in a claim being submitted or paid.  You must submit a valid eClaim  (in the normal way) for the medical aid to make a final adjudication on benefits payable.

In short, eQuotes occur prior to a service being provided (to establish benefits covered), whereas eClaims  occur after the service has been provided (to obtain payment).

Note that some medical aids (e.g. Discovery) refer to eQuotes as "virtual claims".  eQuotes are only available from participating medical aids.

Click here to view a sample of an eQuote.