Claims relating to treatment for my 6 year old daughter's KIDNEY CANCER which is a PMB are routinely rejected. Profmed is required by law to pay for these. When I query these rejected claims, I am faced with clearly untrained and very rude call centre agents such as Portia, who could not understand that one would not phone for authorisation of a myriad of medical tests on the eve of a routine visit to the doctor on the off chance that one of those would result in any myriad of PMB conditions.
What I really fail to understand is that Profmed staff who should be well versed in the law and rules guiding medical aids still do not understand or care enough to look at the invoices sent before routinely refusing payment.
I AM SICK AND TIRED OF HAVING TO FOLLOW UP ON EVERY CLAIM BY EVERY SERVICE PROVIDER FOR MY DAUGHTER'S CONDITION.
I fear that I have exhausted the possibilities of resolving these routine non-payment of claims and would have to involve the Council for Medical Schemes to get Profmed to pay.
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