GEMS "PROCEDURES" RESULT IN CLAIM BECOMING STALE DESPITE PROMISES OF PAYMENT

<p>See the following link for full story.</p> <p> </p> <p> https://hellopeter.com/gems-government-employees-medical-scheme/reviews/gems-refuse-to-pay-out-my-6-month-old-claim-despite-giving-authorisation-for-procedure- ********** </p> <p> </p> <p>Since I've posted this complaint, GEMS undertook to pay the account on 29/7/2016. On that date, they claim the codes are wrong. Then they SMS me the claim will be paid on 12/8, and yet again, on that date, the message came " claim stale".</p> <p> </p> <p>I've been in contact with a Mrs Botha and Mr Carlo Titus as well as on email with his teamleader. He promises to get back to me on that Thursday, yet Thursday came and gone, with no response. Even emails from my attorney are being ignored. One advisor said that they require authorisation to remove the stale before it can be processed for payment. (24/8/2016)</p> <p> </p> <p>Today when I phoned GEMS, they said that the claim is with stale dept. and that it needs to be authorised as PMB and that it will then take another 2 weeks. I spoke to Lynette Hermans who refused to assist me, saying that they only talk to the doctors.</p> <p> </p> <p>The procedure was on 15/1. Today is 13/9 and YET STILL NO PAYMENT. Ombudsman complaint to be filed this evening.</p> <p> </p>