GEMS LACK OF CARE OF ONE OF THEIR OLD MEMBERS

I’m writing this to state the treatment that the fund and its service providers has metered out at Ms S. Sokhulu with Memebrship Number: *** who is on the Emerald Plan on the recent hospitalisation and the later discovery that the funds have been depleted. Whereas she has been upto date with her premiums and her health profile is known knowledge since you pay for her medical costs. On the 28/09/2020, my mother whos a sole member and dependant of the fund was admitted to The Bay(Netcare) Hospital as a result of collapsing upon where she suffered a mild stroke and was taken to the said facility to receive medical attention, to which she did though not satisfactory since as a fund you pride yourselves in having the best case management system for diabetic and the elderly. Furthermore , she was then transferred to a facility in Durban upon where she was going to attend more Specialist Physicians in order to get further medical attention. Upon arrival at the Durban Medical Facilities, the fund approved her admission and since patient data for admission is vital, we as next of kin were not notified since she was no longer as healthy as was before the mild stroke. Various tests were conducted in order to ascertain what procedures were required to be perfomed, which amongst others an operation was to be perfomed on her. However, it was all shocking to discover that her funds have been depleted and the said operation cannot be performed as a result of this discovery. To add injury, none of this was communicated to us as a family and she was later discharged without getting the proper attention she needed. The fund that she has been a member in good standing as a result of paying all monthly premiums can manage to treat in such an inhumane way and where she mostly required the medical attention, she was left in the care of the family and also told to wait for next year in order for the funds to be cleared, which I find very disturbing considering that this year had an interruption in the form of COVID-19. We would like to request a breakdown that led to such depletion of funds in order to perform the said operation and also the people responsible. Failure to meet such request within your organisational compliance framework, we will be forced to seek other legal avenues at our disposal in order to get my mother the treatment she deserves. Hope that my dissatisfaction will be urgently attended.