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wiegenhagen.n wiegenhagen.n

1 reviews | Active since Jul 2017

08 Feb 2019, 12:39

Gems:

I am disgusted with Gems. I rarely use my medical aid for myself. Only the basics. This year I had to go to a specialist to look at my jaw that have been giving me problems. I paid the specialist out of my pocket. When I had to go for general anesthetics in hospital I had to fight with gems to give authorization. Now after I have paid R 2200 for the Specialist I only received R 270 back. They are claiming that is the rate they pay for a consultation. In today's day in age it is pathetic to think that it is a proper rate to pay. Nothing is that cheap anymore especially a specialist. Gems rate went up this year ....I suddenly have to pay in on medicine that I never had to. And I only receive that back.......I had to threaten Gems to get my authorization, If I could I would have left gems today.

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Replies (2)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply08 Feb 2019, 14:31
Official
Good day

Thank you for affording us the opportunity to respond. We are looking into this and will provide feedback. 

Kind regards
The GEMS online team
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply22 Feb 2019, 16:14
Official
Good day
 
Thank you for affording GEMS the opportunity to respond to your concerns.
 
Kindly be advised that GEMS paid the claim at scheme tariff. However,  the healthcare practice charged above the scheme tariff. As a specialist the doctor is not obliged to charge medical aid rates. May we suggest that you take this up with the practice.

The claim was processed accordingly by GEMS.
 
We trust the above is in order.
 
Yours in service, 
The GEMS online team