1 reviews | Active since Sept 2016
Profmed medical scheme enough to make you royally p@#$%!d
We joined Profmed in Jan to get away from Discovery health and our medical bills not being paid. I know we have a 3 month waiting period which is why we activated the PPS wallet to start from Jan. However, the PPS wallet was not activated even though they were gladly taking the money. They even deducted double the amount for the PPS wallet stating that the reason why it was not activated was that they had not been deducting the amounts, so they put a double deduction in place. They then asked if we wanted the money back or to put a hold on the next 3 months to balance the deductions. We opted for the 3 month hold period, which has not been implemented as they have once again deducted R 2 000 off our account. Not only that, but they have not paid for a single medical bill from the PPS wallet stating that it is outside our benefit period, when it should have been activated from Jan. I have emailed them copious amounts with the medical bills that need to be paid from the PPS wallet and everyone says I must wait for April when the PPS wallet is also then activated and they will backdate the payments. Even the PMB bills they did authorise and agree to pay were paid to the pharmacy when I had clearly paid it out of my pocket, and I had sent the proof to them, and now I have still not been refunded for this, as the pharmacy has not refunded me yet. It has been an absolute nightmare and everyone is just apologising profusely but this does not help when the problem is not resolved. It does not matter how nice you are if you can't do the job then don't offer something you cannot deliver on. We are told that the PPS wallet is a new product, but clearly, it is not working. I am very disappointed in the service we have been given as we had been told that the money in our PPS wallet was for use on the procedures we choose and not dictated by the medical aid as to which medical provider we can and cannot see, as had been the case with Discovery health. Furthermore, the medical treatment that has been recommended for a PMB condition has been rejected by the medical aid stating they do not pay Section 21, however!!!!!, this should still be coming from our PPS wallet or day to day funds once the waiting period has been lifted. They do not read their emails as it clearly stated that it was an estimate and we needed auth for this, but they just reject it stating they do not cover section 21 from PMB section, but what about covering it from the day to day section or PPS wallet. Why must I do your work for you, and tell you where to take the money from. why must I tell you who to pay the money to when I clearly sent you proof of payment, you would think they would pay the member then? To say I am disappointed is stating it mildly, I am royally p#@$%!d.
