ZM
Zamaswazi M

1 reviews | Active since Nov 2011

29 Sept 2025, 15:22

GEMS should close down.

I have 1 issue regarding 3 different dates:

1 - My daughter was admitted at Sandton Mediclinic on 08.03.2025 by either D Goossens or Dr Flack (they work in the same practice. Dr Harrisberg a pediatric cardiologist was called in, and the medical did not make payment for this consultation that happened in-hospital. R4 773.60 of R14 561.40 was paid and I was told that is the maximum the medical aid is paying, the R9 787.80 I will see to finish. 2 - July 2025 my daughter was admitted, same hospital, same doctor and there was a shortfall of R2 375.70 because the patient was discharged in the afternoon. the hospital did update authorization for a PM discharge on 18.08.2025 and it was still declined due to no clinical indication. I am not sure if the expectation was that pictures were supposed to accompany the report the was sent on 18.08.2025 for it to be validated. 3 - August 2025 my daughter was admitted, same hospital, same doctor. Her medication (polygam) was approved after a back and forth with the medical aid but funny enough I have a R7 324.35 bill to pay because the medical aid claim this was not submitted. the invoice sent through by the hospital has a payment of R5 010.10 and the shortfall of R7 324.35.

Why does GEMS still exist? Am I not paying my premiums on time? Is the issue that I have a child that is in hospital every month? And he agents, Lord knows the ladies a super rude over payments they do not process.

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Replies (1)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply29 Sept 2025, 16:35
Official
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