Gross incompetence and miss use of customer funds

I am appalled at the manner in which Gems has handled my fund and subsequent queries and complaints by myself on numerous occasions have fallen on deaf ears. I went to a pathologist in July who then informed me afterwards that my medical bill to the amount of R1360.10 has not been paid by Gems. It led to me almost being blacklisted by Ampath. This is the first time I've ever went to a pathologist which is a specialist service surely covered on its own by Gems. They never gave me any explanation as to why it was not paid and i cannot seem to get through to any competent person to give me a valid reason. I pay a lot of money every month towards my medical aid and hardly ever make use of it but with Gems our funds seems to always be exhausted, they never pay most medical emergencies which is outrages. I am done trying to beg them to sort this mess out. My next step will be the Ombudsman if someone in Management can't resolve this for me asap.