Gems claims department sucks

I'm so disappointed and totally disgusted with the poor service delivery from Gems. I am registered on the maternity programme, and have 9 urine tests available. Gems managed to get it right the first two times I went to the gynaecologist, they paid for my urine tests on 27/8 and 28/9. This left me with 7 urine tests provided for in the Care Plan.

On the 23/11 I had my next appointment, Gems rejected the urine test claim from my gynae. On the 13/11 I called Gems to query the rejected claim, they said they'd follow up but I didn't receive feedback. On the 18/11 I called again, I spoke to Angelo, who said that he could see the query on the system and that it hadn't been attended to. He then escalated the query, and promised that it would be resolved. (Reference number MH***). THIS STILL HAS NOT BEEN RESOLVED.

My next appointment at the gynae was in 20/11. Again, my urine test was rejected by Gems. So in 3/12 i called Gems again, I spoke to Buyisile who said that the matter would be escalated to her team leader for resolution and that she would contact me with feedback. I have received absolutely no feedback to date, AND THE MATTER HAS STILL NOT BEEN RESOLVED! So we're now standing on 2 unpaid urine tests which cost R33 each. (Call number 3 reference number MH***)

Today (10/12) I followed up again, call number 4. I spoke to Busi who said that the claim that has now been escalated TWICE has still not been attended to. She is no escalating it to her team leader for the THIRD TIME. She tried getting hold of her team leader who was apparently in a meeting, I held the line for more than 15 minutes while she searched for a team leader. She also promised to provide feedback before 4 pm today.

Your service is absolutely appalling to say the very least. You have an amazing maternity section with caring and helpful staff. But your claims department sucks to say the least. I would really appreciate it if a team leader or senior officer could contact me TODAY, it's been a month since my first call about this issue and it has still not been attended to. This is not acceptable.