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Amanda L

1 reviews | Active since Apr 2024

11 Nov 2025, 08:55

GEMS WILL NEVER STOP FAILING THEIR PATIENTS!

With GEMS you unfortunately have to fight your way forward for every little thing! You even alert them of a *****ulent transaction that a Radiology department is trying with submitting a claim but with no further a due. I was hospitalised in September due to becoming paralyzed for no reason. I had one normal x-ray in casualty and that was it. I was admitted and only after my Neuro-Surgeon came to see me after a day or so, then only was I taken for an MRI scan. My Doctor registered a PMB condition for Hemi, Tetra and Paraplegia. It was approved. As always, GEMS don't wan't to pay for my scan. This is not flu. I was paralyzed in my lower body. How will the Doctor know what is wrong if they do not do a scan? Again GEMS failed me over and over and over yet again. GEMS know that I have active Systemic Lupus and knows all the negatives outcomes of it and how it can play a role in every part of my body. I feel that GEMS should pay that MRI because of the approved conditions. What about the future GEMS? You are the worst Medical aid! Your staff are also very rude!

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Replies (2)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply11 Nov 2025, 09:19
Official
Good day,

Thank you for engaging with us.  We are following your message, and feedback will be provided. If you have an urgent query, please contact us on:  ***(members Toll-free number) & ***(providers).

 Call Centre Hours: Monday - Friday: 8h00 - 17h00 & Saturday: 8h00 - 12h00.

 Emergency number: ***(available 24 hours)

 If you wish to submit a compliment, please email us on at ***. 

 We look forward to receiving your positive feedback. 

 Regards, GEMS
AL
Amanda L's update12 Nov 2025, 17:52
Reviewer Update
Unfortunately you do not stick to your guns yet again. I spoke to a man from the PMB department yesterday whereby he said that he will make sure that the account will be paid. He said he is from the PMB department/ Claims department himself. Why phoning me and hush hush yet again, and today the service provider tell me otherwise and that is that GEMS is not going to pay my scans. Why all of a sudden the Radiology department claims an amount of in the R30 000 but with us it was just over R12 000. I am warning you about this service provider. So even though I have a PMB condition, you are just leaving your patient in the dark yet again and again. You are recognising my PMB condition by allowing me to go for treatment on the 17th of November but you don't wan't to recognise my PMB condition when it comes to paying scans. How do you think will the specialist know where the problem of my paraplegia come from if he does not do an intensive scan? I could have been paralyzed for the rest of my life if this scan was not done and the NEUROSURGEON did not see that my spinalcord were compressed.

I will not apply for Ex Gratia. This is a matter of being ashamed of my Medical Aid. These scans should be paid as part of a starting point of a treatment plan of giving me back my legs.