6 months of waiting for reimbur*****t

Service dates: 15 October 2021, 03 November 2021 and 17 December 2021 On 17 December 2021 I was hospitalized and 31 December 2021 I emailed the necessary documents for reimbur*****t. Below are some of the excuses I got during the follow ups 1. The consultant said I must provide ID, proof of residence and banking details. I did and he asked why I emailed a utility bill. According to me a utility bill serves as proof of residence then later accepted it and said they will process but never did. On the next follow up consultant said nothing was done after the call. 2. This other day they indicated that the claim is old and should have been submitted within 3 months. I told them that I did send within the required time frame and have since made numerous follow up but still no assistance 3. The consultant once said the query was closed without being resolved. I asked her to reopen it because it’s not my fault they haven’t assisted me thus far 4. on one of my follow ups it was said that it will be sent for processing and will receive money 9 June. No payment was received thereafter. 5. after 9 June I made anther follow up. The consultant said the query will be escalated for urgent response since the last one did not escalate it and **** that the next run would be 24 June 2022 6. I made a follow up after 24 June 2022, the consultant said there was no run on 24 June 2022, and the run is 1 July 2022 and said that she will escalate the matter to team leader. 7. 27 June I made my last follow up. The consultant said I should have made a follow up after 72 working days not 48hours later and then hanged up on me. I called again only for the call to be answered by her again and said that she will escalate the matter. ( of which I doubt she did cause I still haven’t received any payment to date) 8. The reference number for my last call was MH***

On 15 October and 03 November 2021 I had to buy injections that GEMS said they will reimburse once the doctor has written a motivation indicating reasons for those injections. I had two options to be hospitalized and receive the injections so that GEMS can pay under hospital benefits or buy injection and be reimbursed. For cost containment merger I opted to buy the injections. Since December I have made follow ups until I gave up June. Reasons for nonpayment where that 1. They needed a motivation from the doctor. I gave them the letter 2. The claim is too old yet the initial email requesting a reimbur*****t was sent December 2021. 3. They requested banking details. The details where emailed but they still did not process 4. They requested practice no and for what I was treated for. The details where on the motivational letter by the doctor 5. On my last call they said the query was closed without being resolved and will re-open it. I then stopped calling