Gems risking patient's health to avoid paying providers

I have treated a patient for over 6 months with Gems taking me from pillar to post to get an authorization. When i finally did, they rejected a whole 18 days costing my practice about R60 000 saying the claims are stale.

I had called the same Gems when they were delaying to tell them that I dont want my clains to go stale whilst they are deliberately delatlying to approve my authorization request. The case managers kept on requesting for prescription i sent over and over again. Also they took about i called them for over two weeks with the claims department telling me that the auth department has techninal problems, but when i finally found the auth department and complained of how they are not communicating, they told me there was no technical.problem.

2 more cases of visitor patient's claims going stale because auth was deliberately delayed. I have taken a decision that i will not accept any Gems patients in my practice anymore and so did a couple of my fellow practice owners because we are taken advantage of. Now my heart bleeds for the poor patients who have to travel for more than 2hrs to get dialysis yet they are paying medical aid