GEMS denied urgent hospital admission for Sudden Bilateral Profound Hearing Loss

I have been a GEMS member since 01/03/2026. Member No: *** Dep 07.

On 10/06/2026 my ENT specialist, Dr Essa, diagnosed me with Sudden Bilateral Profound Sensorineural Hearing Loss and wrote an “urgent” referral for hospital admission due to “concern for microvascular occlusion”. The referral stated “Urgent review”.

I app**** for hospital authorisation through GEMS. Authorisation number: *** Diagnosis: SUDDEN IDIOPATHIC HEARING LOSS Result: DENIED - R0.00 PMB: Emergency = NO

GEMS app**** a 12-month condition-specific waiting period because my hearing loss started March 2025.

My issue: Sudden sensorineural hearing loss SNHL is time-sensitive. My specialist marked it “urgent” and “concern for microvascular occlusion” because treatment must start fast to avoid permanent deafness.

The Council for Medical Schemes PMB list covers medical emergencies. GEMS coded this as “PMB Emergency: NO” and denied cover during the waiting period. I believe this contradicts PMB regulations which require 100% cover for PMB conditions regardless of waiting periods.

I have asked my doctor to send GEMS a PMB motivation letter, but I want GEMS clinical team to urgently review auth *** and reclassify this as a PMB emergency.

What I want resolved: 1. GEMS clinical team to review and approve hospital authorisation *** as a PMB emergency. 2. Written explanation for why “Sudden Bilateral Profound Sensorineural Hearing Loss” with an urgent ENT referral was coded PMB Emergency: NO.

I have attached: Dr Essa’s referral letter + GEMS denial screenshot.

I will also be lodging a complaint with the Council for Medical Schemes if this is not resolved urgently.

Desired outcome: Urgent approval of hospital admission as PMB so I don’t lose my hearing permanently.