GEMS DOES NOT WANT TO PAY MY dr AND I HAVE BENEFITS

<p>After my wife was pregnant we registered her for maternity programme and we were given Care Plan. We consulted Gynae 3 times and was told that from the 4th consultation benefits will come from Specialist benefits. We consulted 3 times again all in all is 6 consultations</p> <p> </p> <p>GEMS told me that many time. What I’m not happy about now is that I have 3 specialist benefits available but GEMS does not want to pay them to the Gynae. I have been calling Since July 2016 and have been given References and told me that They will pay in the next run.</p> <p> </p> <p>The option that I'm under told me that They have sent payment Instruction to Claims and Claims does not pay with no reason.</p> <p> </p> <p>I’m really frustrated and don’t know what to do anymore. If anyone can assist men with Ombudsman contacts or even gems management or something this has been going for long.</p> <p> </p> <p>Now the Dr handed over my Account to Lawyers who’s call me and want money which i don’t have.</p> <p> </p> <p>I'm really Disappointed with The way GEMS has been handling my care, it clearly shows that they are doing something wrong because one department says I have benefits and the other one does not want to pay saying that "Limit/Savings exhausted or Treatment not<br /> covered"</p> <p> </p> <p>imagen how much airtime I used to call from July till today, They even tells me that my log for calls is too long.</p> <p>TODAY i RECEIVED EMAIL FROM THE DE</p> <p> </p> <p>"Dear Sir</p> <p> </p> <p>Please refer to attached document URGENTLY. Unfortunately we have received no payment from GEMS with regards to your wife’s consultations. You have to pay this account in full and claim the money from GEMS as we are no longer prepared to wait for payments from GEMS. Our terms are strictly 30 days. If the medical aid fails to pay within the 30 day limit, it remains the responsibility of the member to pay the outstanding account.</p> <p> </p> <p>Please settle according to terms set out in attached document, and send us proof of payment to......</p> <p> </p> <p>MY PROBLEM IS I DONT HAVE THE MONEY I PAY GEMS EVERY MONTH</p> <p> </p> <p> </p>