PJ
Patrick J

1 reviews | Active since Feb 2021

07 Apr 2026, 15:43

Declining Service and Unacceptable Policy Changes – POLMED Medical Scheme

I am extremely disappointed in how POLMED Medical Scheme has deteriorated over the years, particularly regarding the so-called “Aquarium Package.”

Recently, my daughter injured her ankle, and we consulted a doctor who, out of medical concern, referred her for X-rays and a sonar. This was not a decision I made lightly or without professional guidance. However, to my shock, POLMED rejected the claim, stating that under the Aquarium Package, X-rays and sonars are only covered in life-threatening situations.

This raises serious concerns. Since when are diagnostic tools like X-rays and sonars reserved only for life-threatening cases? How are members expected to properly diagnose injuries before they become critical? The logic behind such a policy is deeply flawed and, frankly, alarming. It makes one question the competence of those responsible for these decisions.

I am also aware of colleagues whose children faced genuinely life-threatening medical emergencies, yet POLMED failed to cover even a reasonable portion of their treatment costs—despite prior authorization being granted. This inconsistency further erodes trust in the scheme.

If POLMED no longer intends to provide the level of cover previously associated with the Aquarium Package, then they should be transparent about it. Members deserve clear communication regarding benefit changes. In the past, X-rays and sonars were covered—what has changed, and why were members not properly informed?

With recent reports about challenges facing schemes like Government Employees Medical Scheme (GEMS), one cannot help but wonder whether POLMED is facing similar internal issues. Given the broader concerns around mismanagement and *******ion in various sectors, these experiences only add to growing suspicion and frustration.

After more than 20 years of loyalty, I can confidently say: this is not the POLMED we once trusted.

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Replies (3)
Polmed
Polmed's reply07 Apr 2026, 16:59
Official
Hello Patrick Julies,   
 
Thank you for submitting a comment to us through Hello Peter.
 
 This is to confirm that we have received your comment and that we are currently investigating this matter.
 
 Our representative will be in touch with you shortly to discuss this matter and ensure that it is speedily resolved.
 
 Kind regards 

POLMED Team 
PJ
Patrick J's update15 Apr 2026, 12:42
Reviewer Update
Thank you for your detailed response and for outlining the scheme’s benefit structure.
It is certainly reassuring to know that access to essential diagnostic services, such as X-rays and ultrasounds, is contingent not on a doctor’s clinical concern, but rather on whether the condition meets the specific criteria of a Prescribed Minimum Benefit.
I appreciate the suggestion to amend the diagnosis; however, it is somewhat concerning that appropriate medical care appears to depend more on administrative coding than on the professional judgment of the treating doctor. The referral for radiology was made based on legitimate medical concern, not as a discretionary request.
While I note that a revised claim may be submitted, it is equally noted that approval remains uncertain regardless of medical necessity. This raises understandable concerns about the practical value of the cover provided under the current benefit structure.
I also acknowledge your commitment to providing “excellent service,” although in this instance, the experience has unfortunately reflected a significant gap between that commitment and the actual support received.
I trust this matter will be reconsidered with due regard to both medical necessity and member expectations.
Polmed
Polmed's reply15 Apr 2026, 13:10
Official
 
Hello  Patrick Julies,   
 
 Thank you for submitting a comment to us through Hello Peter. 
 
 As per the interaction with our representative, we hereby confirm that this matter has been attended to and will be resolved shortly.
 
 We apologise for any inconvenience caused to you. 
 
 Regards 

POLMED Team