GEMS INEFFECTIVE AND BEYOND UNACCEPTABLE (LACK OF) SERVICE

I am writing to formally lodge a complaint regarding the unacceptable service experienced when attempting to obtain authorization for major surgery through GEMS. On multiple occasions, our practice has had to make five separate calls to their offices in order to obtain authorization for ONE patiennt, each time enduring excessive delays. Calls are typically answered only after approximately 1 hour and 10 minutes, followed by an additional 30 minutes on hold, ultimately resulting in no meaningful feedback. This is not only inefficient but also highly disruptive to the functioning of a medical practice that must prioritize patient care.

The process of attaching a request to a member’s profile, referring it to medical advisors, escalating it, and requesting overrides has proven unnecessarily cumbersome. Each step requires repeated calls, draining valuable time and resources. Such inefficiency is unacceptable for a healthcare service provider, particularly when dealing with urgent matters such as surgical authorizations.

This situation places an undue burden on healthcare professionals and compromises patient care. It is imperative that GEMS reviews and improves its call-handling procedures and authorization processes to ensure timely, reliable, and professional service.

This matter should be investigated and corrective measures be implemented without delay. Patients and healthcare providers alike deserve a system that supports, rather than obstructs, the delivery of essential medical services.