MF
Michaela F

1 reviews | Active since Jul 2023

09 Feb 2024, 08:54

Claims

What do I do in this case? As I am going back and forth.

I visited a network GP, however when the claim came through it stated that the GP had charged a rate higher than the agreed rate, I then notified the GP of which they told me that they do not put in their own amounts, the amounts automatically picks up when they submit the claim on their system with my surname and that I should contact my medical aid to sort this out. Upon enquiring with GEMS call centre agents, I am told by the agent that I should go back to the GP and tell them to call the provider, whilst in the same sentence the call centre agent tells me that he can see on the system that the GP had already made contact with the provider, and then told me that he can do nothing from his side regarding this.

So in essence what's the point firstly of paying medical aid but you still paying out of pocket fees even though you abide to the rules and visit a network GP to avoid extra costs. Secondly why is there a call centre if I am told I that nothing can be done?

Trusting i could get a answer on here.

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