Profmed Medical Scheme
Claimed Business
|1|20 Reviews (last 12 months)|This business does not respond to reviews
Profmed Medical Scheme
Claimed Business
|1
20 Reviews (last 12 months)
Does not respond to reviews
AI Review Summary
Based on recent customer reviews, Profmed Medical Scheme is drawing significant frustration from long-standing members who feel let down when claims, authorisations or chronic medication requests are needed. A recurring theme is unanswered emails, unresolved escalations, and a malfunctioning mobile app that blocks logins and membership card access. Members consistently mention disputes over hospital plan coverage, prosthesis approvals and billing accuracy on Profmed Wallet statements. Positive sentiment is rare but does surface around specific frontline staff at the Parktown walk-in office and client services agents who treat members with patience and courtesy.
Performance(last 12 months):
Trustindex Rating
2NPS Score
-45Unlikely
TrustIndex
2
NPS Score
-45
Recommended: Unlikely
Review Distribution
1|20 Reviews
Sep '25 - Aug '26
Recent reviews (20)
Used this business recently? Share your experience to help others decide.
Used this business recently? Share your experience to help others decide.
Share Your ExperienceBB
Beth B
1 reviews | Active since Apr 2018
19 May 2026, 16:05
Request for Medical Advisory Board Rationale – Endoscopic vs Open Spinal Surgery
I will post the email i sent more than 3 weeks ago which they have not had the decency to respond to.... Good afternoon This is email is with regards to the pre-authorisation obtained for patient Mishke Buchanan (auth number:***) The initial authorisation for Unilateral biportal endoscopic (UBE) surgery at Mercantile Hospital was declined. I would like to know the exact reason why the medical advisory board declined authorisation for endoscopic approach but authorised an open procedure. Research clearly shows that performing an endoscopic approach for spinal decompression has less risk of infection, reduced bleeding rates and quicker recovery. By forcing the patient to undergo open surgery she is now having to endure severe pain, extended sick leave and a far longer road to recovery. I have been a member of Profmed for 10years and have generally been happy with the service received but I am struggling to understand the reason behind this decision. As the surgery was of an urgent nature and we did not want to prolong it any longer due to the severe pain my wife was in, we ended up accepting the decision and she underwent open spinal decompression yesterday. I have not managed to find any specific exclusion criteria on your website with regards to endoscopic spinal surgery. I do not believe it was declined based on the plan that I was on as the feedback from pre-auth was that “Profmed does not cover endoscopic spinal surgery”. Your website states verbatim "Profmed’s vision is to address the healthcare needs of South Africa’s professionals. This is achieved through the tailored and comprehensive design of benefits that suit the specific requirements of professionals”but your decision has now resulted in a professional attorney being unable to work for at least the next month most likely 6 weeks and increased her post op complications significantly. If the endoscopic procedure was declined purely based on operating costs involved, I would expect a tailored medical aid such as Profmed to look at the bigger picture in terms of : extended time in hospital, increased risk of complications, extended rehabilitation and prolonged time to return to work. These decisions should be based on evidence based medicine and what is best for the patient in terms of long term outcome. Should you continue with declining minimally invasive procedures, which is the direction that surgery is moving, you will find that you will end up having to cover far more medical costs in the long run with added complications and rehabilitation costs. I urgently await response from the medical advisory team as I would like to advocate for better decision-making with regards to minimally invasive procedures in the future. This has not only impacted my direct family but will impact the patients that myself and other doctors care for. Regards Dr Beth Buchanan (***9)
Helpful (0)
|Replies (0)BB
Beth B
1 reviews | Active since Apr 2018
19 May 2026, 16:05
Request for Medical Advisory Board Rationale – Endoscopic vs Open Spinal Surgery
I will post the email i sent more than 3 weeks ago which they have not had the decency to respond to.... Good afternoon This is email is with regards to the pre-authorisation obtained for patient Mishke Buchanan (auth number:***) The initial authorisation for Unilateral biportal endoscopic (UBE) surgery at Mercantile Hospital was declined. I would like to know the exact reason why the medical advisory board declined authorisation for endoscopic approach but authorised an open procedure. Research clearly shows that performing an endoscopic approach for spinal decompression has less risk of infection, reduced bleeding rates and quicker recovery. By forcing the patient to undergo open surgery she is now having to endure severe pain, extended sick leave and a far longer road to recovery. I have been a member of Profmed for 10years and have generally been happy with the service received but I am struggling to understand the reason behind this decision. As the surgery was of an urgent nature and we did not want to prolong it any longer due to the severe pain my wife was in, we ended up accepting the decision and she underwent open spinal decompression yesterday. I have not managed to find any specific exclusion criteria on your website with regards to endoscopic spinal surgery. I do not believe it was declined based on the plan that I was on as the feedback from pre-auth was that “Profmed does not cover endoscopic spinal surgery”. Your website states verbatim "Profmed’s vision is to address the healthcare needs of South Africa’s professionals. This is achieved through the tailored and comprehensive design of benefits that suit the specific requirements of professionals”but your decision has now resulted in a professional attorney being unable to work for at least the next month most likely 6 weeks and increased her post op complications significantly. If the endoscopic procedure was declined purely based on operating costs involved, I would expect a tailored medical aid such as Profmed to look at the bigger picture in terms of : extended time in hospital, increased risk of complications, extended rehabilitation and prolonged time to return to work. These decisions should be based on evidence based medicine and what is best for the patient in terms of long term outcome. Should you continue with declining minimally invasive procedures, which is the direction that surgery is moving, you will find that you will end up having to cover far more medical costs in the long run with added complications and rehabilitation costs. I urgently await response from the medical advisory team as I would like to advocate for better decision-making with regards to minimally invasive procedures in the future. This has not only impacted my direct family but will impact the patients that myself and other doctors care for. Regards Dr Beth Buchanan (***9)
0
Replies (0)A
Anonymous
1 reviews | Active since Nov 2016
14 May 2026, 10:29
NO PROFESSIONALISM WHATSOEVER!!! /
I have been going back and forth with client services / pharmacy benefits for 60 days now. A claim was sent by Clicks Valleyview on the 10th of March and later reversed , this was confirmed by client services and pharmacy benefits. However my statement still doesn't reflect the correct amount 60 days later!!! Please sort this out . Calls get transferred then dropped, very rude and unprofessional service
Helpful (0)
|Replies (0)A
Anonymous
1 reviews | Active since Nov 2016
14 May 2026, 10:29
NO PROFESSIONALISM WHATSOEVER!!! /
I have been going back and forth with client services / pharmacy benefits for 60 days now. A claim was sent by Clicks Valleyview on the 10th of March and later reversed , this was confirmed by client services and pharmacy benefits. However my statement still doesn't reflect the correct amount 60 days later!!! Please sort this out . Calls get transferred then dropped, very rude and unprofessional service
0
Replies (0)A
Anonymous
1 reviews | Active since Apr 2017
17 Apr 2026, 11:27
Profmed Bureaucratic Nightmare
A bureaucratic headache. I will be out of the country for 3 months so my doctor supp**** a prescription and noted on same that I needed 3 months of my chronic meds. I sent an email to claims@profmed 3 weeks prior to filling my prescription with copy of prescription attached, advising that I would be out of SA for 3 months. As Profmed did not have the courtesy to reply I assumed that all was well. However when attempting to obtain my meds from Dischem, the request was rejected. The very patient and helpful lady at Dischem then called Profmed and was transferred to the chronic section who advised her that I needed to fill out a form. I then asked to speak to the Profmed agent to find out why my email was not sufficient and why they had not responded. The agent refused to speak to me. The Dischem lady was then shuffled between 4 Profmed departments all of whom refused to speak to me but promised to send me the form. I then called the Profmed line and finally was connected after 3 tries. And after the tedious security questions, before I could voice my complaint, I was cut off. I then tried to find a way to register a complaint on the Profmed App. Another nightmare. Even though the App welcomed me by name, so presumably I was logged on, every time I tried to access a function it asked me to log on again and then decided that my logon credentials were wrong - they were not. In all a wasted journey to Dischem and three hours of my life lost. Never mind the stress of dealing with this. Profmed you are supposed to help people get better not to possibly make them ill through the stress of dealing with you. And now I have to find this form and send it. Who knows how long they will take to respond. Why extra paperwork. Why is the doctor's instruction on the prescription for 3 months med not sufficient. Pofmed you used to be really good to deal with but you have gone down hill. No doubt soon we will be dealing with a cold hearted AI Bot on the end of the line. You need to do better
Helpful (0)
|Replies (0)A
Anonymous
1 reviews | Active since Apr 2017
17 Apr 2026, 11:27
Profmed Bureaucratic Nightmare
A bureaucratic headache. I will be out of the country for 3 months so my doctor supp**** a prescription and noted on same that I needed 3 months of my chronic meds. I sent an email to claims@profmed 3 weeks prior to filling my prescription with copy of prescription attached, advising that I would be out of SA for 3 months. As Profmed did not have the courtesy to reply I assumed that all was well. However when attempting to obtain my meds from Dischem, the request was rejected. The very patient and helpful lady at Dischem then called Profmed and was transferred to the chronic section who advised her that I needed to fill out a form. I then asked to speak to the Profmed agent to find out why my email was not sufficient and why they had not responded. The agent refused to speak to me. The Dischem lady was then shuffled between 4 Profmed departments all of whom refused to speak to me but promised to send me the form. I then called the Profmed line and finally was connected after 3 tries. And after the tedious security questions, before I could voice my complaint, I was cut off. I then tried to find a way to register a complaint on the Profmed App. Another nightmare. Even though the App welcomed me by name, so presumably I was logged on, every time I tried to access a function it asked me to log on again and then decided that my logon credentials were wrong - they were not. In all a wasted journey to Dischem and three hours of my life lost. Never mind the stress of dealing with this. Profmed you are supposed to help people get better not to possibly make them ill through the stress of dealing with you. And now I have to find this form and send it. Who knows how long they will take to respond. Why extra paperwork. Why is the doctor's instruction on the prescription for 3 months med not sufficient. Pofmed you used to be really good to deal with but you have gone down hill. No doubt soon we will be dealing with a cold hearted AI Bot on the end of the line. You need to do better
0
Replies (0)SD
Siyachuma D
1 reviews | Active since Jan 2019
27 Mar 2026, 11:43
Useless online registration
Canceled my discovery plan to join them. Their useless online application system keeps giving errors and I'm told to restart the application
Helpful (0)
|Replies (0)SD
Siyachuma D
1 reviews | Active since Jan 2019
27 Mar 2026, 11:43
Useless online registration
Canceled my discovery plan to join them. Their useless online application system keeps giving errors and I'm told to restart the application
0
Replies (0)RN
R N
1 reviews | Active since Mar 2009
10 Feb 2026, 08:58
Total service failure
Can't get a response to a claims query. Can't get help to register for a chronic medication. THE call center is a joke, calls are never answered and agents don't return calls and/or don't follow through. Profmed needs a real wake up call. I get hugely better claims service form Dotsure for my dogs.
Helpful (0)
|Replies (0)RN
R N
1 reviews | Active since Mar 2009
10 Feb 2026, 08:58
Total service failure
Can't get a response to a claims query. Can't get help to register for a chronic medication. THE call center is a joke, calls are never answered and agents don't return calls and/or don't follow through. Profmed needs a real wake up call. I get hugely better claims service form Dotsure for my dogs.
0
Replies (0)AH
Anneli H
1 reviews | Active since Aug 2020
29 Jan 2026, 06:24
Horrible feedback and communication.
For a medical aid claiming to be for professionals, they have very unprofessional ways to treat their members. I have trouble on the app, and if I can't register, they won't pay. I have sent an email to the email provided on the app on 21 January 2026 and never got a response. This seems to be a trending problem with Profmed. Nothing gets done unless you phone and fight and threat. What a pathetic excuse of a medical aid for "professionals"
Helpful (0)
|Replies (2)AH
Anneli H
1 reviews | Active since Aug 2020
29 Jan 2026, 06:24
Horrible feedback and communication.
For a medical aid claiming to be for professionals, they have very unprofessional ways to treat their members. I have trouble on the app, and if I can't register, they won't pay. I have sent an email to the email provided on the app on 21 January 2026 and never got a response. This seems to be a trending problem with Profmed. Nothing gets done unless you phone and fight and threat. What a pathetic excuse of a medical aid for "professionals"
0
Replies (2)pM
peter M
1 reviews | Active since May 2014
22 Jan 2026, 17:41
Disgraceful, disgraceful, disgraceful
I have been a member for some 40 years and I am on the hospital plan… normally the hospital plan covers in hospital procedures ONLY… But when I had to go into theatre in hospital to have multiple extractions and dental work they say such things are not covered by the hospital plan and that I would have to have it done in the dentist chair presumably under local anaesthetic. The surgeon insisted that this required a general anaesthetic in hospital given that the operation was complex took 100 minutes… if they tried to do that in a dentist chair in a normal surgery , which is covered they say by my medical aid hospital plan, it would’ve risked my life… So 40 years of payments with no claims for in hospital procedures, when I needed Profmed the most they let me down badly… disgraceful, disgraceful disgraceful
Helpful (0)
|Replies (1)pM
peter M
1 reviews | Active since May 2014
22 Jan 2026, 17:41
Disgraceful, disgraceful, disgraceful
I have been a member for some 40 years and I am on the hospital plan… normally the hospital plan covers in hospital procedures ONLY… But when I had to go into theatre in hospital to have multiple extractions and dental work they say such things are not covered by the hospital plan and that I would have to have it done in the dentist chair presumably under local anaesthetic. The surgeon insisted that this required a general anaesthetic in hospital given that the operation was complex took 100 minutes… if they tried to do that in a dentist chair in a normal surgery , which is covered they say by my medical aid hospital plan, it would’ve risked my life… So 40 years of payments with no claims for in hospital procedures, when I needed Profmed the most they let me down badly… disgraceful, disgraceful disgraceful
0
Replies (1)EB