GEMS medical aid incompetence

After months of frustration, this seems like the only way to get an appropriate and timeous response from this organization.

My wife joined GEMS in November 2022 and listed myself and her mother as dependents. Prior to joining, we had spent weeks ensuring that the scheme covers certain medications ( namely CGM sensors) for diabetics to which we were told that they do cover the specific item across all plan options.

I had gone to the specialist doctor in order to get a script sent to GEMS. once we had submitted the script and all documentation, GEMS responded by saying that we needed to get a script from the designated network doctor, which we did.

We were then told that the item was not part of the chronic benefit . We were then told to get the item prescribed by a specialist, which is what we tried to ensure the first time around.

once again , we were told that the network doctor had to prescribe it. (basically made us run from pillar to post)

we had tried calling in only to be attended to by many confused individuals who could not provide any answers or understand the situation. We got told we would receive call backs but this never happened . Each time we enquire, we are given the same automated response, that our query will be attended to.

They then send us mails weeks later, to tell us that they could not link up any enquiry to the member in question, even though we had provided the enquiry number. Whats worse is that on the very same reply from GEMS, the member number is right there on their letterhead! how is it possible not to be able to link anything together if they responded to my email address, already showing the membership number.

I have sent in many emails asking to please call me back , each time explaining the entire situation. they even get other medication quantities wrong I am now at wits end and my health is being affected. Not sure what to do anymore. In hindsight, it feels like i should never have left my previous medical aid provider. GEMS does a good job at fooling you into thinking you will be in capable hands. I am now FEARFUL for my health