This is a formal letter that is sent either via post or as an email attachment, clearly indicating the purpose of the communication. A written appeal must be legible and contain all the relevant membership information, including personal information, a membership number and dependant codes, as well as Scheme option. The decision against which the appeal is being made must be clearly stated and all the supporting documents must be attached. The appellant must send the written request to the relevant department within 30 days of receipt of the outcome or decision:
By email: By post:
Medicine (POLMED Chronic Medicine Management) – firstname.lastname@example.org
Hospital (POLMED Hospital Risk Management) – email@example.com
Specialised dentistry – firstname.lastname@example.org
Ambulatory prescribed minimum benefits (aPMBs) – Care Templates – email@example.com
Private Bag X16
by hand delivery to the nearest Client Service Centre in your region.
The department will forward your appeal to the Clinical Committee. While your appeal is being processed, you may get a letter asking you to provide more information or documentation. If you send this information to us, we may be able to informally resolve your case fairly quickly.
For urgent matters, feedback on the resolution of the dispute is provided in writing within five working days after receiving all the necessary information.
Non-urgent matters are discussed at the Clinical Committee review meeting, which sits once a month. Feedback is provided in writing within five working days after the meeting.
Should you still not be satisfied with the outcome of the above processes, you may lodge a complaint with the Council for Medical Schemes by using one of the following channels:
- Post: Council for Medical Schemes, Private Bag X34, Hatfield 0028
- Phone: 0861 123 267 (share call from a Telkom landline) or
012 431 0500
- Fax: 086 673 2466
- Email: firstname.lastname@example.org