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Dental Pre-authorisation

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Dental Pre-authorisation

Certain dental procedures that are performed in-hospital and out-of-hospital require pre-authorisation, i.e. before they are performed. The POLMED payment rules, clinical protocols and guidelines will also apply.

After assessing the appropriateness of the procedure, POLMED will communicate the outcome of the pre-authorisation request to the member and treating provider.

Please refer to the current POLMED Guide to Your Health booklet for more information about dental benefits and pre-authorisation requirements.

What information does POLMED need in order to provide pre-authorisation for a dental procedure?

  • Full diagnosis of the condition (ICD-10 codes)
  • Treatment plan (tariff codes)
  • Clinical motivation
  • Teeth numbers
  • Laboratory codes (where applicable)
  • Clear X-rays

Remember: If the above information is not provided, POLMED may not be able to authorise the procedure.

Please note

  • A co-payment of R5 000 applies if pre-authorisation is not obtained for in-hospital dental procedures.
  • A co-payment of R500 may apply for out-of-hospital specialised dentistry procedures if pre-authorisation is not obtained, e.g. crowns, bridges and orthodontic treatment.
  • Dentists will be reimbursed from out-of-hospital benefits.

Click below to view the Dental pre-authorisation process
Dental pre-authorisation process

Contact details
In-hospital dental procedures pre-authorisation:

Tel: 0860 765 633
Fax: 0860 104 114
Email: polmedauths@medscheme.co.za
Mobi: Download the free POLMED Chat app on your mobile device.
Web: Log in to the Member zone and click on the POLMED Chat widget/icon.

Out-of-hospital specialised dentistry in doctors’ rooms:
Contact POLMED to confirm available benefits and, if required, complete pre-authorisation:
Tel: 0860 765 633
Email: dental.polmeddental@medscheme.co.za
Mobi: Download the free POLMED Chat app on your mobile device.
Web: Log in to the Member zone and click on the POLMED Chat widget/icon.