1 reviews | Active since Dec 2013
GEMS Left My Lupus-Diagnosed Mother in Hospital for Over a Week Without Authorising Her Treatment
I am writing this on behalf of my mother, who has been a GEMS Medical Aid member for the past 4 years. She was diagnosed with Lupus in 2024 and has required ongoing treatment ever since. I am posting this publicly because we have exhausted every other avenue, and her health cannot wait any longer.
In October 2025, my mother was admitted to hospital and required a Polygam infusion. Her doctor submitted all necessary documentation and medical motivation — yet GEMS claimed to have received nothing. After resubmission and confirmation of receipt, one department approved the treatment while another denied it. My mother was forced to leave hospital and travel over 400km back home, only to return 1.5 weeks later. On arrival, she was told the treatment was "approved" but not "authorised" — a distinction that was never explained and cost her nearly two weeks of her health and her time. It took a further 3 days before authorisation was finally granted.
As of 3 June 2026, my mother is back in hospital requiring the same Polygam treatment. The exact same situation is happening again. Her doctor has submitted all required medical notes and letters — multiple times — and GEMS continues to request the same documents in a loop. After more than a week of back-and-forth, she has only been approved for 1 bottle of treatment when she requires 6. She is still in hospital. Her condition is worsening.
My mother pays her premiums every single month without fail. She has done everything asked of her. Her treating physician has provided a full medical motivation. There is no justification for this delay.
This pattern of administrative failure is not just an inconvenience — it has caused serious, measurable harm to my mother's physical and emotional well-being. No chronically ill patient should have to fight this hard for treatment that is medically necessary and fully supported by her doctors.
GEMS, I am urgently requesting that you intervene immediately and authorise the full course of Polygam treatment for my mother. Please do right by your member.
Authorization number ***8. Member: Mala Gopaul Doorkapersadh
#GEMS #GEMSMedicalAid #Hellopeter #Lupus #MedicalAid #SouthAfrica #ChronicIllness
The doctor had to discharge my mother, she has to get transport to travel back to her home, which is 400km away.
How is this working towards a "healthier you"
Absolutely disgusting from a medical aid already knowing her situation and already having all the necessary docs from the doctor.
The doctor had to discharge my mother, she has to get transport to travel back to her home, which is 400km away.
How is this working towards a "healthier you"
Absolutely disgusting from a medical aid already knowing her situation and already having all the necessary docs from the doctor.
My mother needed the treatment 8 days ago, now she has to wait a further 7 days meaning more than 2 weeks for treatment, that's just wild!
But when payment needs to be made for medical aid, it has to be done immediately, what a shame!
My mother needed the treatment 8 days ago, now she has to wait a further 7 days meaning more than 2 weeks for treatment, that's just wild!
But when payment needs to be made for medical aid, it has to be done immediately, what a shame!
Having a patient in hospital keep on calling, emailing, getting doctors letters, etc , should be unacceptable when there is a critical illness involved.
I am sure you get this a lot, but please put yourselves in the patience shoes, consumers are being left helpless and hopeless when dealing with Gems and their policies and procedures which are all against the consumer.
Having a patient in hospital keep on calling, emailing, getting doctors letters, etc , should be unacceptable when there is a critical illness involved.
I am sure you get this a lot, but please put yourselves in the patience shoes, consumers are being left helpless and hopeless when dealing with Gems and their policies and procedures which are all against the consumer.
Please note that my mother had to get discharged on the 12th of June because the treatment was not authorized, and on the way back from the hospital to her home (400km away), she was involved in a car accident and had to recover.
She had called GEMS today to inform them that she will be at the doctor on the 24th of July for the treatment. Now they say that the authorisation was in June, but the Doctor confirmed that the authorisation expires at the end of July 2026.
The call centre agent said they cannot do anything, which is so frustrating! Once again, the push and shove has begun, and each person you talk to is saying "no, not this department", or "we cannot help"
Once again, I am pleading with you to please escalate this matter and confirm with the doctor and patient that the treatment is authorized!
Please note that my mother had to get discharged on the 12th of June because the treatment was not authorized, and on the way back from the hospital to her home (400km away), she was involved in a car accident and had to recover.
She had called GEMS today to inform them that she will be at the doctor on the 24th of July for the treatment. Now they say that the authorisation was in June, but the Doctor confirmed that the authorisation expires at the end of July 2026.
The call centre agent said they cannot do anything, which is so frustrating! Once again, the push and shove has begun, and each person you talk to is saying "no, not this department", or "we cannot help"
Once again, I am pleading with you to please escalate this matter and confirm with the doctor and patient that the treatment is authorized!
The doctors office had contacted your call centre and they informed the doctor office that they have to redo the process, meaning the same letters to be resent etc.
When the doctors office informed them that they received an email that authorisation was granted before and expires at the end of July 2026, they verbally said it will be authorized.
Why is it that we always have to go back and forth with GEMS. Please make sure it is authorized before my mother goes in for treatment which is the 24th of July 2026.
The doctors office had contacted your call centre and they informed the doctor office that they have to redo the process, meaning the same letters to be resent etc.
When the doctors office informed them that they received an email that authorisation was granted before and expires at the end of July 2026, they verbally said it will be authorized.
Why is it that we always have to go back and forth with GEMS. Please make sure it is authorized before my mother goes in for treatment which is the 24th of July 2026.