POLMED – FROM A MEDICAL AID WE COULD TRUST TO A CONSTANT BATTLE FOR CARE

I have been a POLMED member for many years, and I never thought I would reach the point where I would describe my experience with POLMED as a constant battle to obtain medically necessary care.

I have one simple question for the POLMED Board and those responsible for managing the scheme:

How did we get here?

A few months ago, my doctor referred me to a urologist because of a medical condition. After examining me, the urologist determined that I required surgery urgently. I followed the specialist's advice and underwent the procedure and hospitalisation.

POLMED approved and paid for the surgery and hospitalisation.

But here is where I simply cannot understand POLMED's approach.

After the operation, I was placed on medication and instructed by the specialist that my condition must be monitored. I was told that I need follow-up consultations approximately every six months to determine how my condition is progressing and whether I will require another operation in the future.

Yet POLMED is now refusing to pay for the specialist follow-up consultation required to monitor the condition and determine whether further surgery will be necessary.

Read that again.

POLMED paid for the operation.

POLMED paid for the hospitalisation.

But now POLMED does not want to pay for the specialist to monitor the condition after that operation and determine whether another operation will be required.

I have also experienced problems with POLMED paying for the medication related to my condition.

How is this supposed to make sense?

If a specialist says a patient requires follow-up monitoring after surgery, how can that follow-up simply be treated as though it is unrelated or unnecessary?

Are members expected to wait until their condition deteriorates to the point where another hospital admission or operation becomes unavoidable before POLMED is prepared to pay?

This is exactly what frustrates me about the direction POLMED appears to have taken.

I remember POLMED as a medical aid where members could have confidence that their healthcare needs would be taken seriously. Today, it feels completely different. Members are increasingly left fighting over authorisations, consultations, medication and benefits while trying to deal with their medical problems at the same time.

I want to ask the POLMED Board directly:

Who is POLMED being managed for?

Is it still being managed primarily with the health and wellbeing of its members in mind, or has financial cost-cutting become the dominant consideration?

I understand that a medical scheme has rules, benefits and financial responsibilities. I am not asking POLMED to pay for unnecessary treatment.

I am asking why a medically necessary follow-up consultation, directly connected to a procedure POLMED already approved and paid for, is now being refused when that consultation is needed to determine whether I will require further surgery.

This is not simply about one consultation. It is about the principle.

Members pay their contributions month after month because they expect their medical aid to be there when they need medical care.

A medical aid should not only pay when a patient is lying in a hospital bed.

It should also support the follow-up care, monitoring and treatment required after that hospitalisation.

POLMED was once a medical aid that many of us could depend on. My recent experience has left me asking what happened to that POLMED.

To the POLMED Board: How did we go from there to here?

Because from where I am standing, the member is no longer feeling like the priority.

After years of contributing to POLMED, I should not have to fight my medical aid for the specialist follow-up required to monitor a condition for which POLMED has already approved and paid for surgery.

POLMED, I am asking you to seriously reconsider how you are treating your members. Healthcare should come before bureaucracy and cost-cutting.