GEMS reject claim procedure

My name is Thulasizwe Gumede, work at the Department of Education, Reference Number: ***, Member Number: *** (EMERALD). The grown procedure was rejected and advised by the GEMS consultant to apply for Exgratia payment for that procedure I have not received the feedback yet and it is almost a month, I hardly used my medical aid and I have been a member since 2010 and I never sleep even once at the hospital but for one claim they are failing to process my claim WHY? And I know very well there are sufficient funds for the procedure, GEMS are crocks.