POLMED Member Queries Process

Name of the Organization : POLMED
Type of Facility : Member Queries Process
Head Office : Arcadia

Website : https://www.polmed.co.za/members/my-medical-scheme/query-process/

POLMED Member Queries Process

** If you have a query and would like to speak to a POLMED Client Service Call Centre agent you can contact POLMED via telephone on 0860 765 633.

Related : POLMED Claims Submission Process : www.southafricain.com/2539.html

** Alternatively send your query/application via fax to 0860 104 114 or send an email to polmed AT medscheme.co.za

Note :
** The Administrator has five (5) working days to respond to and resolve your initial enquiry.
** Always obtain a reference number and name of the agent.
** It is extremely important that you follow the correct process in order for us to assist you.

Member Queries (Initial Query) :
Admin/Managed Care (Clinical)/General Queries :
** These are queries you raise with the Administrator when you initially experience a problem with or require information with regard to any medical scheme-related matter.
** A reference number will automatically be supplied to you when you submit your query via email.

** Remember to also obtain a reference number and the name of the agent when you report any matter to POLMED’S Client Service Call Centre.
** Submit your query to polmed AT medscheme.co.za

Provide the following information for the Administrator to investigate your query :
** Membership number
** Patient name and surname
** Dependent code (i.e. 01 – refer to the back of your membership card)

** Date of service
** Name of the provider
** Practice number of the provider
** Details of enquiry that may further assist POLMED to investigate the matter
** Supporting documents i.e. invoice / statement / medicine – or medical procedure declined

Member Queries Escalated

** These are queries that serve as a follow up to your first query after you have not received satisfactory feedback/service.
** The query received at POLMED will be investigated and feedback will be provided to the member within a minimum of five (5) working days.

** The number of days depends on the complexity of the enquiry i.e. more information required from the member/provider to resolve the query.
** Send an email to polmedhouse AT medscheme.co.za

Provide the following details for POLMED to investigate your query :
** Membership number
** Patient name and surname
** Dependent code (i.e. 01 – refer to the back of your membership card)
** Reference number obtained from the Administrator (you should have requested this when the initial query was raised)
** Date of initial enquiry
** Details of the enquiry that may further assist POLMED to investigate the matter

Additional Polmed Contact Details

** Chronic Medicine Management registration: polmedcmm AT medscheme.co.za
** Ambulatory Prescribed Minimum Benefit (APMB) registration: polmedapmb AT medscheme.co.za
** Hospital pre-authorisation: polmedauths AT medscheme.co.za
** POLMED Chat (via mobile device): Download the free POLMED Chat app on your device
** POLMED Chat (via POLMED website): Log in to the member zone and click on the POLMED Chat widget/icon

Client Service Call Centre And Regional Offices : Operating Hours
** The POLMED Client Service Call Centre and Regional Offices operate Mondays to Fridays from 7:30 to 17:00 (excluding public holidays).
** Please click here to view the address details of the various Regional Offices.

Compliments :
** If you want to submit a compliment about a positive experience that you had with the Scheme, send an email to polmed AT medscheme.co.za and include the details of your experience and the name of the agent who assisted you.

Online/Social Media Comments And Queries :
** The POPI Act prohibits the Scheme from disclosing any member’s personal information to third parties without a member’s consent.
** It is for this reason that POLMED cannot communicate with you via any social media platform such as Facebook, Twitter and Instagram or any other social medium.

** POLMED further has an agreement with the Administrator whereby we monitor their level of service offered to members.
** If the formal processes are not followed, it is impossible to monitor or measure these service levels.

Some Important Information From Comments

Comments:
1. I am writing this message very disappointed by Polmed service regarding the benefits that are forever not paid in time for consultations and hospitalization short falls. I am constantly phoned by different doctors personal assistance regarding their money which Polmed didn’t pay. Please assist me.

2. I have been trying to request hospital authorization for two weeks without any success, very disappointed in Polmed response. It was never like this before.

3. I called in twice this morning requesting for authorisation approval because the doctor did not receive it and he needed it asap. I left my email address but still waiting. Each time, I called they told me its approved and the authorisation was sent but, its difficult for them to resent the approval to me. Please I need assistance as soon as possible because the doctor is waiting.

Information:
Most of the commenters commented that, they are facing the problem while trying to request hospital authorization

Functions of POLMED South Africa

POLMED, also known as the South African Police Service Medical Scheme, is a medical scheme that provides healthcare benefits to South African Police Service (SAPS) employees, pensioners, and their dependents. The functions of POLMED in South Africa include:

Providing comprehensive healthcare coverage:
POLMED offers medical benefits and cover for a wide range of healthcare services, including hospitalization, general practitioner visits, specialist consultations, prescription medication, chronic medication, maternity care, and emergency medical services.

Managing healthcare claims and payments:
POLMED processes and manages claims for healthcare services rendered to its members. This includes receiving and adjudicating claims submitted by healthcare providers, and reimbursing members or directly paying healthcare providers for eligible services, in accordance with the benefits and rules of the scheme.

Managing network of healthcare providers:
POLMED has a network of contracted healthcare providers, including hospitals, doctors, specialists, pharmacies, and other healthcare facilities. The scheme manages relationships with these providers, negotiates payment rates, and establishes networks to ensure access to quality healthcare services for its members.