GEMS, are you doing your job?

I have been claiming back from a medical expense since May. Today was the last straw for me. after months of emailing and phoning GEMS, I finally realised that this Medical Aid has no intention of helping me.

I went to a clinic on the 26/04/2018, my claim was made in the first week of May. My caim was just over R10 000. There were several times that I called in and after going from one line to another, amendments were made to my claim as instructed by the medical aid. After a month or so, when I would phone in again, I would be told that my claim has been escalated as a matter of urgency, or I would be told it hasn't been received and there are no claims on my profile, or I would be told that there is a claim for a nursing agency, which should not be on my profile and belongs to another GEMS Client not on my profile.

About 3 weeks ago, I was informed that I would be paid R600, of the claim of R10 000, over the weekend, the amount was never paid. I have since called GEMS twice.

Today when I called in, the GEMS consultant, whose name I wish I had taken particular note of, basically told me, that there is no way I can expect him to help me if I cant submit a claim on time. When I explained that this has been an ongoing process for several months, he told me to prove it. I said that I have made numerous calls, and that it should reflect on my profile on their system, I also told him I have proof of all the emails I have sent in and only ever received an automated response. He informed me that without a reference number I cannot prove anything. He was rude and unprofessional. I said that no-one is willing to help me and that I have been going in circles for months, he continued to tell me that it is my own fault for not submitting on time (which I had!).

I finally said that I need to consider moving to another medical aid that will take me seriously, he hung up. Since then, this man has blocked my online profile and I have no access to any of my medical information, tax certificates, claims, etc.

This has been the worst possible service and I will move to another medical aid at the soonest possible chance.