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mariannemsmit M

1 reviews | Active since Aug 2016

04 Feb 2025, 18:03

Someone should send Profmed to the Medical Aid Ombudsman.

I am absolutely sick of jumping through hoop after fire engulfed hoop only to get nowhere. Emails go unanswered, the call centre keeps redirecting me to a different department and then drops the call, and the online chat option is beyond useless.

Since when does Profmed require a full list of symptoms to authorise medication on chronic? Since when is a patient responsible for giving them ICD-10 and Nappi codes?! Since when do they ignore motivational letters from doctors because they want a blood test for a measurement that is no longer used to prescribe medication for a condition that I will literally die of without medication?!?!

I have spent literal hours on the phone with Profmed, MediKredit and doctors’ receptionists, only for me to end up exactly where I began. They keep changing the system and when I ask what is needed for them to process my medication, they cannot give a straight answer.

I pay them over R60 000.00 a year and still have to pay for medication out of pocket because they refuse to pay the provider and/or they refuse to pay for medication, hospitalisation, etc. I have NO control over what medications I need and what doctors bill for in hospital. And gap cover doesn’t cover the gap.

Absolutely useless. I am moving from Profmed after being a member since 1996 because I have just had enough. And to any Profmed people reading this to remediate the situation - don’t even bother. It makes no difference; and attempting to placate me has lead nowhere. Fool me once, shame on you. Fool my twice - not happening.

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Replies (3)
Profmed Medical Scheme
Profmed Medical Scheme's reply07 Feb 2025, 10:35
Official
Dear Ms Smit
 
Thank you for reaching out to us. We understand that your medication was already approved.

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 ***.
mM
mariannemsmit M's update07 Feb 2025, 11:06
Reviewer Update
My medication was only approved after I had to ask my mom to phone. I asked her because she has been helping me with getting chronic authorisation since I was 12 and is a medical professional so she would know better how to navigate the system. I have been doing the chronic authorisation myself since I went on my own scheme, but have had so many struggles over the years, I just had to ask her for help. My mom also spent hours on the phone, had to hang up and phone me to get my doctors’ practice numbers and copies of everything I had already sent Profmed - motivations, scripts, results from my Libre Sensors… Then she had to phone back and escalate the issue to the most senior person to get the medications authorised. The fact that she has been dealing with this type of thing for over 20 years and she was so upset and frustrated after also jumping through all the hoops is a testament to how flawed your system is.

I completely understand that people take chances and that protocols exist for a reason. I get it! But after being with Profmed for as long as I have and having NEVER been dishonest with you in any way, I would sincerely hope that your staff would at least make somewhat of an effort to assist and not frustrate members to the point of wanting to leave. Streamline your system and ask the programmers to add a notes section where staff can make comments about members to better assist them. This whole situation has been an utter waste of time.

The ONE good thing was a phone call from a lady named Martie who phoned after everything was approved just to check in. She made all the difference.
Profmed Medical Scheme
Profmed Medical Scheme's reply10 Feb 2025, 14:16
Official
Dear Ms Smit

Suggestions are always welcomed – thank you.
 
We understand clinical protocols and processes can be very confusing and received reassurance from our contracted provider that the required processes and requirements were reiterated telephonically, in writing and were well received.