Gems won't pay a claim

<p>The service was rendered on the 14 July 2016, Authorisation number: ********** 1 membership ********** 01. The amount charged by the service provider is R14 070.25 and Gems only paid R1866.45. When i called to find out why a lady by the name of Lutendo told me that the claim was processed under normal claims and it will have to be reprocessed because the authorisation number was not used when processing the claim, the procedure is not under normal claims and that i would receive feedback within 48 hours. I never received any feedback so i called again and i spoke to a lady by the name of Abigail and she told me that the claim won't be reprocessed because the limit for the year has been exceeded. What i don't understand is that why am i getting two different responses and why gems is not getting back to me like promised? This is something the baby was born with and always gems taking me up and down and i always have to hold on the line for nearly an hour and that is costly, first they made me pay R36000 early this year which they did refund us after so much sweat. The lady who got us the authorisation said the medical aid would cover all the cost and now i am getting "benefits exceeded" i don't understand.</p>