1 reviews | Active since Nov 2013
Anything to decline medical services being a PMB condition!
My experience, which is unfortunately and as yet not over, has been horrible and totally unprofessional!
My daughter had a serious accident where she dislocated her elbow and tore ligaments etc and broke bones in her lower leg/ankle. 1 It took Profmed over 2 days to authorise an MRI when the doctor was required to operate and fix the injuries to the elbow (initially Profmed tried to convince everyone that the daughter's condition was not a PMB condition). It was eventually only approved after the MRI had been done and the operation already performed; 2 When we requested wound care for the ellbow approximately 1 1/2 weeks after the operation via our broker, Profmed waited until the wound care had happened (they were informed of the date when authorisation was sought) and we are now told that the wound care request has not been dealt with because Profmed requires pictures of the injury (how pathetic can any excuse be and also, why does Profmed not attend the operation to verify the correctness of claims), not received a quote, require the date when care is supposed to be given, etc.. All of this when Profmed is and has been in possession of a doctor's report following the surgery specifying details of the requirements!; 3 Profmed was further requested to authorise the RMO arm brace which has to date not been authorised, let alone been refunded as I have already paid for it. Once again this was specified in the specialist orthopaedic surgeon's report which is in Profmed's possession; 4 Authority for an operation to fix our daughter's broken lower leg/ankle, scheduled for tomorrow, was requested early in the morning of even date by the attending specialist doctor's office. It is now 16:30 and the authority has as yet not been received (the hospital even enquired why we have as yet not received it).
AT ALL TIMES THIS IS A PMB CONDITION and I wonder whether it will carry on like this as the daughter will require physiotherapy, further wound care, X-rays etc.
I am a working professional and if I were to render services in this manner I would have been out of work a long time ago. Also, will Profmed compensate me for the time I am wasting in an attempt to always resolve all queries and the endless telephone calls?
Today I received an email from an "elbow crutch provider" stating that the crutch had not been paid for - declined by Profmed - in an event of an emergency accident (elbow broken, dislocated and ligaments torn and lower leg broken in various places). How was the injured supposed to move around in the absence of an elbow crutch (we already obtained normal crutches from friends and did not claim from the medical aid) . All of this is PMB
To add insult to injury I also received the hospital account today, showing that an amount of about R 79,000 has not been paid for a PMB (emergency) condition in a hospital with whom Profmed has a so-called agreement .
Also, physiotherapy, albeit pre-approved, is being declined.
When will this stop???? THIS IS URGENT AS A FURTHER OPERATION WILL BE REQUIRED BY NOBODY AT PROFMED SEEMS TO CARE!
Today I received an email from an "elbow crutch provider" stating that the crutch had not been paid for - declined by Profmed - in an event of an emergency accident (elbow broken, dislocated and ligaments torn and lower leg broken in various places). How was the injured supposed to move around in the absence of an elbow crutch (we already obtained normal crutches from friends and did not claim from the medical aid) . All of this is PMB
To add insult to injury I also received the hospital account today, showing that an amount of about R 79,000 has not been paid for a PMB (emergency) condition in a hospital with whom Profmed has a so-called agreement .
Also, physiotherapy, albeit pre-approved, is being declined.
When will this stop???? THIS IS URGENT AS A FURTHER OPERATION WILL BE REQUIRED BY NOBODY AT PROFMED SEEMS TO CARE!