Can Medical Aid Blacklist You??

Can a medical aid society blacklist a member, what can or cannot happen should a member cross the line?

Medical aid schemes can blacklist members where they are suspected of fraudulent or dishonest behaviour. An application can also be rejected based on a previous member blacklist. However, members can still exercise the right to appeal in the event of a blacklist.

The Most Common Reasons Medical Aid Schemes Blacklist People

The most common reason medical schemes blacklist members is when they suspect them of “fraudulent or dishonest behaviour”. This can include:  

  • Submitting false claims
  • Getting treatment for unregistered beneficiaries
  • Abuse of medical aid benefits
  • Misrepresenting facts to get favourable terms.

If you are suspected of fraudulent or dishonest behaviour you will be blacklisted and will no longer be able to access benefits from that medical aid scheme.

Medical aid companies also have the right to blacklist you if they discover that you haven’t submitted all your paperwork with the intention of defrauding the scheme. If you are blacklisted, your medical aid company will not pay any claims until the blacklisting is lifted. An appeal can be made in writing for a review of the blacklisting decision by the scheme.  

It is possible to be blacklisted by a medical aid scheme if you submit false claims. If you are in this situation, then it would be best to contact the medical aid provider and try to resolve the issue as quickly as possible. The provider should give you an opportunity to appeal against the decision. You may also apply for another medical aid if you believe that there has been some mistake.


If you’re blacklisted, you will not be able to access medical services as the claims will not be honoured by the medical aid society. The only remedy is to apply for the blacklist to be lifted through the appeals process. For any medical aid issues kindly contact CellMed Health Medical Fund on 08677 200 200, email or visit our website here.