kR
keitsoketsi R

1 reviews | Active since Dec 2014

10 Aug 2023, 10:31

REFUSAL TO PAY CLAIM

Good morning I recently was added on the high risk martenity plan. My Dr then requested that I go for an NIPT test since my tests results for Down syndrome came back as intermediate risk, I was informed by Polmed that I need authorisation for such a test and it normally takes two weeks to get one. Due to the nature of the test I had to pay from my own pocket and submit claims to the Polmed maternity. I was then taken from pillar to post with regards to my claims payment ,eventually when it was processed I was told I will be paid 513 from the 6000 I paid , this was taken from my day to day pathology funds. I then called Polmed to find out how that is possible ,that my day to day are to be used for an authorised test. I was still taken from pillar to post regarding this until eventually the case manager agreed that a mistake was made and I need to be paid from my maternity benefits. It’s a struggle to get my money again am still being taken from pillar to post. I want my money and am tired of all the customer agents in Polmed not knowing how to assist me. May I please be given a straight answer on how far my file is. Right now I wish I had another option for medical aid , I would definitely cancel my medical aid.

0
Replies (5)
kR
keitsoketsi R's update10 Aug 2023, 10:54
Reviewer Update
I just called the call centre right now and I was put into contact with case manager Monica and she advised me to speak to the claims department cause she has re submitted the claim , I was then put through to the Claims department were u spoke to Babalwa who then advised me that Monica is the one who had to take back my matter to the medical advisor but she has not done so. Babalwa spoke to Monica who **** and said she called me and explained the process to me. Why must she lie? Why must she say she called me whereas am the one who called? She **** and said my claim is with the claims department for re processing but on the system it shows she is the one not escalating it, now she dsnt even want to answer her calls. Can Monica please attend to my claim and do what she is being paid to do and not lie to clients on work she didn’t do. Am tired of this and an expecting. a call from Polmed today or am taking this to the medical aid ombudsman. I have records and names of every single person I have spoken to and I will not take this lying down. Somebody needs to account for this .
Polmed
Polmed's reply10 Aug 2023, 11:03
Official
Hello Keitsoketsi Ramolodi, 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
kR
keitsoketsi R's update10 Aug 2023, 14:30
Reviewer Update
Good day

I see my claim was processed. Please note the money needs to be paid into my account and not into the Ampath account. Also please confirm when is the next payment run
Polmed
Polmed's reply10 Aug 2023, 16:03
Official
Hello Keitsoketsi Ramolodi, 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 now been resolved. Polmed strives to give the best customer service to our clients and appreciate it when you bring your concerns to us as to when we have failed to deliver this service.  We apologise for any inconvenience caused to you.  Regards  POLMED Team
kR
keitsoketsi R's update31 Aug 2023, 06:26
Reviewer Update
Good morning Polmed
As per agreement I was told the refund will reflect on my account on the 31st August 2023,however nothing shows. Please assist on this matter