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Nkateko N
1 reviews | Active since Dec 2018
07 Dec 2018, 21:29
Gems medical Aid claims payment
Im a Gems member who has registered for a maternity programme and have been experiencing problems when it comes to payment of claims. 1st pathology tests related to pregnancy where done and gems paid half the amount, stating ive exceeded my limit while it was my 1st test. Secondly i was admited at net care due to pre-term labour without delivery, the medical aid rejected the claim of R15350 and also the my gynea. ********** 39
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Replies (2)
Gems (Government Employees Medical Scheme)'s replyOfficial
10 Dec 2018, 09:08Good day
Thank you for giving us the opportunity to respond. We are looking into this and will provide feedback as soon as possible.
Kind regards
The GEMS online team
Thank you for giving us the opportunity to respond. We are looking into this and will provide feedback as soon as possible.
Kind regards
The GEMS online team
Gems (Government Employees Medical Scheme)'s reply10 Dec 2018, 09:08
Official
Good day
Thank you for giving us the opportunity to respond. We are looking into this and will provide feedback as soon as possible.
Kind regards
The GEMS online team
Thank you for giving us the opportunity to respond. We are looking into this and will provide feedback as soon as possible.
Kind regards
The GEMS online team
Gems (Government Employees Medical Scheme)'s replyOfficial
10 Jan 2019, 10:42Good day
Thank you for bringing your concerns regarding your unpaid account to our attention.
Kindly be advised that when the pathology claims were initially processed, your maternity benefits had not yet been activated. The claim was therefore settled from the pathology out-of-hospital benefit, which was exhausted.
While most of the hospital account received was approved and processed with the claims run of 14 December 2018, additional clinical information was required for full payment. The required information has now been provided and an additional amount of R1,584.60 was processed and settled with the claims run on 28 December 2018.
Please accept our sincere apologies for any inconvenience caused by the delay.
Kind regards
The GEMS online team
Gems (Government Employees Medical Scheme)'s reply10 Jan 2019, 10:42
Official
Good day
Thank you for bringing your concerns regarding your unpaid account to our attention.
Kindly be advised that when the pathology claims were initially processed, your maternity benefits had not yet been activated. The claim was therefore settled from the pathology out-of-hospital benefit, which was exhausted.
While most of the hospital account received was approved and processed with the claims run of 14 December 2018, additional clinical information was required for full payment. The required information has now been provided and an additional amount of R1,584.60 was processed and settled with the claims run on 28 December 2018.
Please accept our sincere apologies for any inconvenience caused by the delay.
Kind regards
The GEMS online team