Being sent from Pilar to post

An optical claim for member *** dep 03 was submitted on 20th with a motivation letter. We then received an email to submit record card, lab order and invoice which were sent on 25th and on 27th. The claim was rejected due to funds being exhausted. We called to follow up because the patient fid have funds and only the main member had gotten spectacles this year so this could not be possible.

References for our calls Opt/Rea56130 27/11/3024 Opt/Pau11771 03/12/2024 Paulina said there was an error in the rejection and she will resubmit the claim and advised we call back today 05/11/2024.

Today we spoke to Thato Ref Opt/Tha 96364 to follow up. She said she will submit the claim .

The main member was here to follow up on her child's spectacles and we advised she call GEMS directly. Which she did and she called us back and mentioned that there was an error in the rejection of the claim due to funds being depleted. These are just delaying tactics. Today we are being told the Same thing by Thato that Paulina was meant to have done ie resubmit the claim, so basically nothing has been rectified since we spoke to Paulina .... Op