RS
Roline S

1 reviews | Active since Nov 2016

04 Mar 2025, 09:14

Non payment of legitimate claims escalating

Please be aware that Profmed tries to find more and more ways not to pay for legitimate claims. Every time there is more documentation or some report necessary that wasn't the case before. I have been a member for 7 years and I can report that it is a huge problem now. Claims are not paid and the member has to figure out why and is then informed that there was more documentation needed but this was never communicated to the member. I am warning new members or people who might consider joining Profmed of this problem. No communication no payment pf claoms and terrible terrible service.

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Replies (2)
Profmed Medical Scheme
Profmed Medical Scheme's reply04 Mar 2025, 10:27
Official
Dear Roline, we are so sorry to hear that this has been your experience. We have your details and will escalate this with our team immediately. 
Profmed Medical Scheme
Profmed Medical Scheme's reply04 Mar 2025, 16:41
Official
Dear Ms Smith
 
Please be advised that Profmed adheres to the standard guidelines prescribed by the NDoH and NICD; reimbur*****t of a COVID-19 PCR test is subject to a qualifying criteria. The supporting information was requested and received from your treating practitioner, your claim was successfully processed. Profmed is committed to providing you with the highest standard of service and your feedback is important to us, please feel free to use our various support channels including calling ***.