GEM not paying bills

Below is the Letter that was sent to ********** on the 06/02/2018 with no response, also a letter from the doctor was also sent to them. The hospital is still calling us regarding the outstanding amount which is from 2017

TO WHOM IT MAY CONCERN.

My name is Irene Sehunoe.I am writing this letter with regard to a concern I have as I have been told that a child less than a year cannot use the medical aid.

It is unfair of your service provider because a child can get sick at any time, at any day and I choose to have a medical aid so as it can benefit me and my family during those times of ill health. I am thus laying a complaint against you as I do not receive the benefits I am currently paying for.

It is unfair of your service as when I am in need of your help, you on the other hand you cannot provide me with the service that you should be rendering as I have been told to pay for the bill from my own pocket.

I have an eleven month child who was admitted in a hospital from 12 December 2017 until 15 December 2017 due to uncontrollable increase in temperature. I used the medical aid as I believed it could help me to cover the costs, to my surprise I was not suppose to use the medical aid as the child is a minor thus the bill is charged from my own pocket.

The child was taken blood samples to check if there is anything that might be causing this drastic changes and the fee came to be the total amount of R7000.My question is, what is the benefit of having a medical aid when you cannot use it when it is needed? What is the use of me paying for something that is not beneficial for me and my family?

To make the matters worse what was I suppose to do with an ill child in a matter of life and death. I now believe that you do not keep your promises as promised, thus will take the matter to those of the authority for them to help me to settle this matter.

kind Regards

Also receive last in Nov:

Approval/Partial Approval of Request 15 November 2018 This Authorisation is only valid for the specified beneficiary, accommodation level and codes and is dependent on active membership (this excludes suspended membership) and the available benefits. When approving the authorisation GEMS first checks the sub-limits and benefits that are available at the point of request. An approved authorisation is not a guarantee that GEMS will settle the bill in full. It is important to contact the GEMS Hospital Authorisation department in the event of changes; i.e. The date of service/ admission date, length of stay/ required to stay longer, level of care or if there is additional treatment required after the original authorization was approved. Please note that should the patient's stay be extended, GEMS requires an appropriate clinical motivation from the treating service provider, should these not be received the Scheme may decline funding/ paying of the change or additional treatments done after the authorization was approved. Items appearing on the "Medscheme Health Risk Solutions In-Hospital Restricted and Non-Covered Services" list are not covered by this authorisation. Patient name: MR LARONA SEHUNOE Member number / Dependant code: ********** 82/02 Scheme and Option: GEMS, EMERALD Authorisation number: ********** 4 Admisson number: ********** 794 Reason for admission: ACUTE TONSILLITIS DUE TO OTHER SPECIFIED Treating provider: DR NR SEBATA Place of treatment: FERNCREST HOSPITAL Length of stay: 3 Days Admission date: 12/12/2017 Expected discharge date: 15/12/2017 Accommodation required From: To: Paediatrics 12/12/2017 PM 15/12/2017 PM Code Outcome Description J03.8 ICD Approve ACUTE TONSILLITIS DUE TO OTHER SPECIFIED R11 ICD NAUSEA AND VOMITING R50.8 ICD OTHER SPECIFIED FEVER R05 ICD COUGH