FINAL NOTICE BEFORE REGULATORY ESCALATION

To: **Government Employees Medical Scheme (GEMS)**

Good day,

Your failure to respond to prior correspondence regarding the authorised cardiology consultation for dependant is unacceptable and constitutes a serious dereliction of your obligations as a registered medical scheme.

Pre-authorisation was obtained from GEMS prior to the consultation. The service was rendered strictly on the strength of that approval. Your scheme is therefore legally bound to honour the benefit. Any attempt to shift liability onto the member or dependant is ******** and will be treated as such.

The continued silence and non-payment of this account amount to:

* Breach of statutory duties in terms of the Medical Schemes Act * Administrative negligence * Financial prejudice to the member * Unreasonable conduct by a regulated medical scheme

Let it be made unequivocally clear:

The dependant will not assume liability for an authorised consultation.

Should written confirmation of full settlement and zero member liability not be received within **48 hours**, we will proceed immediately with formal complaints to the **Council for Medical Schemes**, including a request for regulatory intervention and investigation into your claims administration processes.

We will further seek all available remedies for financial prejudice caused, including recovery of any associated costs incurred as a result of your failure to act.

Your lack of response will be interpreted as refusal to resolve this matter amicably.

Govern yourselves accordingly.

We expect written confirmation of settlement without further delay.