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Cheryll C

1 reviews | Active since May 2016

13 May 2016, 13:04

Unexceptable Polmed excuses

I want to lodge a complaint against Polmed Medical Scheme. We app**** to have braces fitted for my daughter. The medical aid approved the braces amount 100%. The medical aid approved the payments as follow: a innitial deposit of R6235.08 before braces are fitted and a monthly installment of R765.71 will be paid for 19 months.The 19 months will only end at the end of November 2016. The braces was fitted on 3 May 2015. The deposit of R6235.08 was paid and a monthly fee of R765.71 was paid until the end of December 2015. A new supplier Medscheme took over in 2016. Since January 2016 NO MONTHLY PAYMENTS have been made to date yet. Since the end of January 2016 when the first payment was due to be paid, the medical aid did not make any payments. Me and Intercare phoned and e-mailed them often, and no reason or explanation why or when it will be paid was given. It is now middle May 2016 and STILL NO PAYMENTS have been made. We have lodged 26 different complaints of wich is phone calls and e-mails. Reference numbers were given but no explanations of payments not being made. Today 13 May 2016 i went back to Intercare who phoned them to follow up. Janine who works at Intercare was told that firstly they couldn't get the reference codes, then she was told that there is NO COMMUNICATION between the people working there. The reason for her saying that is that no reference codes were linked to previous codes. The reference codes that i have got is as follow: 180416QPWDWJ, 050516QRHP5X, 060516QRJJRK, 290316QNZHJT, 300316QP1J95, 120416QPMLH3, 180416QPW3GP, 090516QRM8N9, 090516QRMBKV, and that is just to name a few of them. E-mails have been sent by us the members, and Intercare aswell. They keep on saying they did not receive the mails. First it was ICD10 codes that they didn't receive and then it was practicing docters practice number. We have given them both numbers via phonecalls, e-mails and paper claims, but still they didn't want to pay the payments. We have even e-mailed a team leader Mrs. Singh, but did not receive any feedback. Attached is all the reference codes and people that she spoke to, or reason given for non payment from the medical aid. 11-02-2016: patient not registered as beneficiary, 18-04-2016: monthly payment amount is received by scheme but no payment is done yet, called Medscheme, spoke to Clinton ***, - can follow up on 7-10 working days. Clinton said claims was received not processed and without authorization number on system. He will send it to technical and admin for review. Follow up on claims, 03-05-2016, spoke to Brian, ***, claims prossed but not paid, can follow up on 05-05-2016. 06-05-2016, a e-mail was sent to team leader, Mrs Singh at Polmed, e-mail adress that was used was ***. In the e-mail sent to Mrs Singh, the Intercare statements, as well as the orthodontic treatmentplan and x-rays/EDI proof of delivery was sent. The authorization code, including the practicing docters practice number is on all the paperwork sent to them. NO FEEDBACK AT ALL was given after the e-mail was sent to them on the 06-05-2016. Today 13-05-2016, Janine at Intercare phoned then AGAIN but with no luck. She was told that there is NO COMMUNICATION because no reference numbers were connected to previous ones. My problem now is that NO PAYMENTS is being made, NO EXPLANATIONS to why or when it will be paid is given. They keep on saying phone back in a few days for a update. When we phone back they give all different excuses. We are now forced, after Polmed approved the braces 100% for 19 month, to pay it out of our pocket. Is it possible to please get a answer for us to WHY AND WHEN they are going to pay the fees that they APPROVED 100%. Our montly installment towards our medical aid is always up to date. That is why i cant understand after they APPROVED it 100%, what the reason is for NOT PAYING the fees for the braces. The Dentist must still be paid until the end of November, and i don't think it is fair that we have to pay it out of our own pocket after they APPROVED IT 100%. Ï would really appreciate any feedback from Polmed as to when they are going to pay what they approved.

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