1 reviews | Active since Jul 2017
Failure to pay claims and poor service delivery
My name it's Pertunia Khunoana membership number:*** (Emerald)option, im the principal member and only have one dependent(Kelebogile Khunoana).I've done some test July/August 2018, last year January 2019 and also August 2019 only to found out the medical aid didn't pay the Dr and Lancet Laboratory.
Yesterday when I made a call to Gems they told me my funds were finished and I don't understand how come because I dnt go to a Dr frequently especially last year.I ask the consultant how can the funds be exhausted in January because these a new allocation of funds.He told me they paid R750 and it's a lie they didn't pay it even the Laboratory sent me a statement.How can they allocate such a small amount were else all along they were paying according to Dr claims.
Gems Medical aid is failing me because even my daughter went to the Dentist 8 January 2020 but they sent an SMS saying something I dnt understand about paying the claims.
Even in 2016 I paid Lancet for scans that I did at hospital were else the Dr did an authorization before the scans were done and admission.Now the Laboratory send me an email saying I owe R4950 that is too much if I have a medical that I'm paying every month
Yesterday I even tried to pay R1000 because some consultant from Lancet called me on the 14 and 20 January saying I owe them R2210.But only to found out later when I call the Laboratory they are telling me about an added amount I dnt know about.I even have an SMS that was sent last week that state how much I owe at Lancet.
Kindly assist regarding this matter I feel these a foul play between two industries(Lancet Laboratory and Gems) someone is not doing his/her job.Im so feed up and disappointed.Even after I made a call at Gems some consultant said something rude on his background thinking that I dropped the call,i can't say it on this platform.
Pertunia Khunoana ***)
Today morning Lancet Laboratory sent me an SMS that says they have handed my account to Strauss Daly Attorney's and I'm so surprised because I even made an payment arrangement on the phone with the consultant as they say all calls are recorded for security reasons, I told her this month I would pay R1000 and the outstanding R1210 will pay it next month.
Regarding Gems Medical aid I'm still waiting waiting for respond of what is happening of payment of Dr and Lancet Laboratory.Yesterday a consultant frm Gems Medical aid said my funds were exhausted were else it's not true because i went to the Dr in January 2019 which is still early and new allocation of funds were allocated so we're did the funds go.In August 2019 they didn't pay Lancet again but when I asked why,the answer was no funds.I dnt understand all that Gems excuse because I dnt even go to a Dr frequently even my dependent one once or twice a year.So this medical aid must stop treating me as if I'm not paying and start doing the right thing and pay what they have to pay stop this manipulation and disrespecting members.
Regards
Pertunia Khunoana
Today morning Lancet Laboratory sent me an SMS that says they have handed my account to Strauss Daly Attorney's and I'm so surprised because I even made an payment arrangement on the phone with the consultant as they say all calls are recorded for security reasons, I told her this month I would pay R1000 and the outstanding R1210 will pay it next month.
Regarding Gems Medical aid I'm still waiting waiting for respond of what is happening of payment of Dr and Lancet Laboratory.Yesterday a consultant frm Gems Medical aid said my funds were exhausted were else it's not true because i went to the Dr in January 2019 which is still early and new allocation of funds were allocated so we're did the funds go.In August 2019 they didn't pay Lancet again but when I asked why,the answer was no funds.I dnt understand all that Gems excuse because I dnt even go to a Dr frequently even my dependent one once or twice a year.So this medical aid must stop treating me as if I'm not paying and start doing the right thing and pay what they have to pay stop this manipulation and disrespecting members.
Regards
Pertunia Khunoana
I'm very disappointed even today no respond or way forward regarding the payment of claims I'm still waiting or if they can't resolve this situation it's better to go another route because I'm paying every month but they refuse to pay my claims and they are unreasonable and come with excuses
I'm very disappointed even today no respond or way forward regarding the payment of claims I'm still waiting or if they can't resolve this situation it's better to go another route because I'm paying every month but they refuse to pay my claims and they are unreasonable and come with excuses
Today i called Lancet Laboratory asking the payment of funds and balance instead the balance is still the same and nothing is done the consultant said i must communicate with Gems regarding that because they didnt use a wrong code its Gems that rejected the claims.
I'm tired of this whole nonsense because it seems as if I'm being played around.Instead i feel Gems or Lancet undermines the members because to get things done we must fight.Another thing i even paid Lancet Laboratory R1000-00 and i want my money back from Lancet because Gems have to pay the service provider.Sometimes i get very angry and upset because what i pay for i have to fight for it again.
Your urgent cooperation is highly appreciated.
Regards
Today i called Lancet Laboratory asking the payment of funds and balance instead the balance is still the same and nothing is done the consultant said i must communicate with Gems regarding that because they didnt use a wrong code its Gems that rejected the claims.
I'm tired of this whole nonsense because it seems as if I'm being played around.Instead i feel Gems or Lancet undermines the members because to get things done we must fight.Another thing i even paid Lancet Laboratory R1000-00 and i want my money back from Lancet because Gems have to pay the service provider.Sometimes i get very angry and upset because what i pay for i have to fight for it again.
Your urgent cooperation is highly appreciated.
Regards
Today i received an email from Lancet Laboratory with the same balance it seems as if Gems medical aid they disrespecting me now or undermining me because the matter would have been sorted out by now instead the laboratory is busy sending me statements of money that i owe and should have been paid by the medical aid.
I lodged a complain since January about the matter but nothing is been done why were else i pay he medical aid. Im so ****ed of because no one respond or says anything to me instead ive been made a fool by the Medical Aid that i pay every moth.
Your urgent cooperation in this regard is highly appreciated
Regards
PERTUNIA KHUNOANA
Today i received an email from Lancet Laboratory with the same balance it seems as if Gems medical aid they disrespecting me now or undermining me because the matter would have been sorted out by now instead the laboratory is busy sending me statements of money that i owe and should have been paid by the medical aid.
I lodged a complain since January about the matter but nothing is been done why were else i pay he medical aid. Im so ****ed of because no one respond or says anything to me instead ive been made a fool by the Medical Aid that i pay every moth.
Your urgent cooperation in this regard is highly appreciated
Regards
PERTUNIA KHUNOANA