Abused Member of GEMS Medical Aid!!!

To who it may concern.

Its has been almost 2 years now and I am having the most difficult time with Gems Government employment Medical aid scheme. They refuse to pay for the delivery of my baby at Mediclinic Midsteam! I am a personal assist in a government organization and extremely cautious when it comes to handling matters with importance. I did call Gems prior to my delivery and had my doctor motivate the delivery and I have proof that Gems has said there are no Payments or co payments needed by the member. I been calling to the call center to follow up i spend minimum 30 mins on the line when i get trough I explain my situation and suddenly the call gets cut by the call center agent. Finally after spending hours on the line spending R100s of Rands on airtime I get a simple answer that they will look into it which doesnt help me as I now have a bill of more than R14000 to pay and Lexmed continuously calls me harassing me for the money that I do not have and am not liable for. I also have voice recordings of this. If there is some one on this forum that can assis me I will be entirly greatful as I am at wits end and have exausted all avenues. I even tried last year November to down scale my medical aid plan I spent an entire day at the gems offices in pta. To lower my plan from Emerald +- R9000 to berly to a lower amount so I can at least be able to live.Gems have refused couness times to assist I have trails of emails with no response....How can a Medical aid treat their members with such unreliable service even after receiving authorisation and approval of my delivery.

Very Dissatisfied and disgusted by the pathetic service.

This has put tremendous mental emotional strain on my family and my self I am even now afraid to go to any doctor for assistance as I am confident that Gems will not pay.

After going into Spec Savers and being advised by the optometrist that Gems will cover the specs that I need. Suddenly Gems says that they paid the money to a personal nedbank account which is not my account and they now need to reverse the payment and I now need to send bank statements this sounds ********** that a medical aid can make a payment into a personal account with out any verification with its member and then need to reverse the payment because its the wrong account.

Been almost 2 years now still no response regarding all my issues.

Gems gets paid faithfully every month and I dont receive any service back in return. I am totally dissatisfied with GEMS.

I would like for someone to refer me to the highest person I could contact at GEMS.

This is a total *******. If this is not resolved I will seek legal action and go to other media.