Profmed Medical Scheme is the absolute worst for chronic conditions and pregnancy care.

I have been a type 1 diabetic for 18+ years and because Profmed was the medical aid my parents used when I was diagnosed, I stayed on with them when I completed my qualifications since they already had all of my medical information. The plan I’m on is one of the top tier plans. Now, I am pregnant with my miracle baby and I have been battling with Profmed every step of the way. I was hospitalised in my early pregnancy because my blood sugar kept dropping dangerously, multiple times a day. My endocrinologist and obstetrician both sent motivation for me to get an insulin pump, as even somewhat uncontrolled diabetes is not only dangerous for me, but incredibly so for my unborn child. Profmed refused because my control was “too good” (not by pregnancy standards!) and they did not think it was “medically necessary”. Despite expert specialists with more than 60 years of experience in their fields combined determining that an insulin pump was absolutely medically necessary. To be clear: I would have purchased the pump out of pocket. Profmed simply had to pay for the consumables each month as part of my chronic medication benefit. They refused.

I then had complications with my pregnancy and needed nausea medication as well as blood thinners. It took Profmed 3 months to allow my blood thinners onto my chronic benefit, despite several motivational letters sent by various doctors. Then they backdated the authorisation to only a day after the first letter of motivation was sent and would not reimburse me the over R10 000 I had to spend to get the necessary medication. Note: The nausea medication, which costs several thousand a month as well, is still not authorised by Profmed to go off of my chronic benefit.

The latest issue is that Profmed is now refusing to pay for my means of monitoring my blood glucose. I have to test more than 12 times each day, and therefore needed the Libre Freestyle sensors, as Profmed would not allow me more than 50 test strips per month. I would use that up in 3 days, by the way. Despite my endocrinologist sending multiple letters of motivation for my Libre Freestyle sensors, Profmed will not pay - it has to come out of pocket. The Libre system costs R2 000 a month. This is in addition to the money I have to pay in for my insulin, because the insulin I was using before my pregnancy that was fully covered would endanger my baby and needed to be changed.

Not only does Profmed go against what my medical doctors deem to be best for me, they are now purposely endangering my unborn baby’s life as well as mine because they refuse to pay for the most basic form of blood glucose control. I have been doing my absolute best in controlling my diabetes and I will admit that I am doing well. However, so many variables affect my glucose and despite my best efforts, I am still struggling to control my levels at times. My unborn child is at risk of being macrosomic, and now Profmed is taking away the only means they have left me to prevent that. If my baby is born with lifelong complications because of anything Profmed did against my medical team’s advice and numerous attempts at trying to get Profmed to comply, I will sue them, no matter the cost. And the second I can, I will change medical aids. Paying almost as much as my rent each month and having to fight losing battles constantly is beyond ridiculous. And they simply don’t care. I am so fed up and tired of battling to get the most basic necessary medical care from Profmed, having my specialists intervene and then compromise to provide me and my child with the best possible outcome and still losing. Stay away from Profmed if you have any chronic conditions, even more so if you are a woman and become pregnant. They will sidestep your medical team at every step of the way and endanger your life without thinking twice - as long as they can save a few extra bucks. Vile and disgusting.