MG
Mash G

1 reviews | Active since Aug 2016

28 Aug 2018, 15:43

GEMS declines authorization A WEEK LATER, after they initially approved BEFORE procedure

On the 20 August 2018, I received confirmation from GEMS that they have approved all procedure codes and ICD 10 Codes, for a procedure scheduled on the 22 August 2018. Today, 28 August 2018, I receive an SMS stating that the authorization has been denied. Authorization Number ********** 1 refers. GEM ********** 0 refers.

How the hell do you work like this? Based on the approval, the decision was made to undergo the procedure, considering that these medical procedures cost thousands of rands. Furthermore, the reason I pay medical insurance, is to ensure that I have cover, particularly when I follow the stipulated protocol to get authorization...BUT this is ****************.

The only reason I am on GEMS is because it is FORCED upon me by my employer (the government) , otherwise they would not pay my 2/3 subsidy. I am 100% with the National Teachers Union to fight this. We should have a choice to choose a medical aid that suits us and our needs. HAIL DISCOVERY...I have never had a problem with the 10 years I've been with them.

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Replies (2)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply28 Aug 2018, 15:51
Official

Good day

Thank you for affording GEMS the opportunity to respond to your concerns. We are investigating this matter and will provide feedback as soon as possible.

Kind regards

The GEMS online team

Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply03 Sept 2018, 11:52
Official

Good day

Thank you for bringing your authorisation concerns to our attention.

We can confirm that the authorization was approved and the approval letters were sent to the relevant parties.

Our sincere apologies for the delay and for any inconvenience caused as a result.

Kind regards

The GEMS online team