DS
Desiree S

1 reviews | Active since Feb 2016

27 Feb 2016, 11:14

Dental Claim not resolved for more than 8 months

I am a Gems member and am generally very healthy. <br> <br> I have been a gems member since Jan 2015.<br> In June 2015 I went to a dentist for a checkup. The bill came to R538.<br> Within days the dentist contacted me to say that according to the dentistry claims department I was not a member. it was discovered that the main medical aid had not sent my membership certificate to the dental department. They said they would correct this problem and process the claim. <br> In august I phoned again. My certificate still had not made its way to the dental claims department!!! Again they promised to rectify this error.<br> In December my dentist emailed me again to say that they still had not received payment. And now my medical aid said the claim would be processed as a late claim. Old claims where emailed as proof and they swore again it would be rectified.<br> <br> This month (Februaury) the dentist was notified that GEMS would not pay the bill would not be paid as a claim like it had been submitted in 6 month. I have only been to the dentist once!!!!!<br> <br> Today I have spent three hours trying to send the proof of submission to the primecure office again to process the claim. ONLY TO FIND THEIR EMAIL DOES NOT WORK!

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Replies (1)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply29 Feb 2016, 09:36
Official
Hello DesireeZandile,

Thank you for affording GEMS the opportunity to respond to your concerns.
A GEMS consultant will contact you shortly to provide you with the necessary assistance.

Please allow us a little time to investigate your complaint.


Kind Regards,

The GEMS Online Team