GEMS IS A WASTE OF MONEY -PATHETIC SERVICES - SHOULD BE REMOVED FROM GOVERNMENT PARTNERSHIP

I JOINED GEMS MEDICAL AID LAST YEAR JUNE, I THEN ADDED TWO ADDITIONAL MEMBERS IN NOVEMBER 2017. THESE TWO MEMBERS JOINED THE MEDICAL AID WITH EXISTING CONDITIONS . ONE FOR CALLUS , ONE FOR A KIDNEY INFECTION .WHICH I WAS INFORMED THAT THERE IS A 1 YEAR CONDITIONAL WAITING PERIOD.

TWO WEEKS AGO ONE OF THE DEPENDENTS ( WITH CALLUS ) NEEDED TO VISIT A SPECIALIST DUE TO SEVER PAIN IN HER HAND. THE ORTHOPEDIC SPECIALIST INFORMED US THAT THE SHE NEEDS TO UNDERGO CARPAL TUNNEL SYNDROME.

THIS WAS SUBMITTED TO GEMS MEDICAL AID ON THE 17/09/2018. WHICH WAS DECLINED FROM THE MEDICAL AID STATING THAT THERE IS A WAITING PERIOD. WHEN I GOT TO WORK ON 18/09/2018 I SAW AN EMAIL FROM GEMS MEDICAL AID THAT SAID THE AUTHORIZATION IS PENDING AND THE DESCRIPTION FOR THE PROCEDURE SAID : REMOVE ANKLE JOINT LINING

I THEN CALLED NUMEROUS TIMES TRYING TO EXPLAIN THAT PROBABLY THE AUTHORIZATION ESCALATED TO THE UNDERWRITING DEPARTMENT DUE TO THIS DESCRIPTION. NOTES WHERE MADE OF MY CONCERNS AND I WAS INFORMED THAT THE UNDERWRITING DEPARTMENT WOULD RESPOND BY LATEST MONDAY( MAX 4 DAY TIME FRAME).

I THEN CALLED TODAY AS NO MAILS WAS SENT TO ME NOR SMS.

ONLY TO FIND OUT THAT THE UNDERWRITING DEPARTMENT AS NOT RESPONDED AND THAT THE CALL CENTER AGENT WOULD ESCALATE THE QUERY VIA MAIL. AFTER A 35 MINUTE CONVERSATION THE AGENT INFORMED ME THAT THERE WAS NOTHING MORE THAT SHE COULD DO. I ASKED TO BE PUT THROUGH TO THE UNDERWRITING DEPARTMENT , AFTER WAITING ON THE LINE FOR 5 MINUTES THE LINE WAS CUT OFF. I TRIED TO CALL BACK TWICE AND MY LINE WAS CUT OFF AGAIN . ON THE THIRD TIME THE AGENTS FROM CLAIMS AND AUTHORIZATIONS INFORMED ME THAT THERE IS NO WAY TO CONTACT THE UNDERWRITING DEPARTMENT AT ALL AND THAT IS SHOWS ON THE SYSTEMS THAT THE UNDERWRITING DEPARTMENT SHOULD RESPOND BY THE 30/09/2018 DUE TO IT BEING ESCALATED THIS MORNING.

I TRIED ASKING TO SPEAK TO A MANAGER BUT ACCORDING TO THE AGENTS THEY COULD NOT DO THIS .

I THEN SENT THIS MAIL THIS MORNING TO GEMS . BUT UP TO THIS POINT THERE IS NO RESPONSE

Attention Underwriting Dept.

Med Aid no : ********** 56

Dependent :03 Sandra Haniff Ref : Gem ********** 9

call *** \\ MH ********** 1

Kindly note that I , the main member ,has been trying to fast track this ref authorization GEM ********** since 19/09/2018 due to the seriousness of the condition.

I presumed that this authorization had escalated to the underwriting department due to an error from the orthopedic surgeons office stating that is was for an ankle joint instead of the wrist .

Upon speaking numerous times to the call center agents they explained to me that the underwriting department, will undertake their investigations between 2-4 working days as this was an undisclosed waiting period , and the underwriting department needs to establish whether this was a pre-existing condition. They did inform me that they have tried to escalate it via mail and also noted all the concerns I have had .

I have waited patiently for the underwriting department to conclude with investigations in the interim the patient is coping with severe pain medication while her condition deteriorates .

I called this morning to find out if there was any response from the underwriting department however yet again no response and the same procedure followed by the call center agent who kept me on the line for approximately 30-35 mins waiting for a response. I did inform the agent that the patient has now lost her grip, and two fingers are ice cold and if the delay in authorization continued could face the risk of amputating them , which I will hold the medical aid accountable.

I had furthered asked to go through to the underwriting department , after waiting for 5 minutes my call was then cut off. I had called again an upon selecting my options and waiting for an agent to answer my call was cut off yet again.

Kindly take note that I am a very dissatisfied client and will ensure that this matter be escalated to the highest authority if the need be .

My main concern is that the authorization is fast tracked so that we may either proceed or weigh other options.

I am on the lowest scheme that I can afford therefore is imperative for me to first see the outcome of my medical aid and understand why would it be declined and before I go forth with anything else which is unfeasible for me. In the midst of all this the patient is suffering Gopal