FIGHTING FOR MY RIGHTS

Per my schedule of benefits I am entitled to out-of-hospital- physiotherapy for post operation. I have requested authorisation for my physiotherapy but Profmed has declined same as they have advised that my injury is not a PMB. My operation was just over 2 weeks ago. Profmed is fully aware of the scope and extent of my operation and injury, which they approved as a PMB. I highlighted that they ought to peruse my medical records, which they are in possession of, and which will clearly indicate the severity of my injury. I have been requested to again send a further email explaining my injury and situation. PMB legislation states that a mere knee dislocation is a PMB, my injury far exceeds just a knee dislocation. I have to constantly try and fight for my rights and benefits under this policy. A patient should not have to follow up and argue to receive a benefit which is rightfully due to them. This request for authorisation has been going on since my operation.