Hospital bill not paid and treated like a ********

I have never been made to feel so small fighting for my child to be assisted and humiliating myself Infront of people that were looking at me at the walk-in centre for the service I am paying for every month, it made me sick my blood pressure was high, and I was emotional for a good three weeks due to the ill-treatment I received and your staff's incompetence. Unfortunately, this is still a persistent matter whenever I enquire about this it, I am given new excuses each time.

On the 24 April 2024 I took my daughter to the doctor's room for a consultation as she had been complaining about the pain due to a swollen cheek and pain in her left jaw. The doctor found that she had SEPSIS, CELLULITIS OF FACE. The doctor then advised that she needed to be admitted and be under the antibiotic drip to clear/reduce the sepsis since she could not be taken to the theatre at that immediate moment as it was risky. He also alerted us that it was an emergency and that we could not wait for the weekend as the sepsis could easily move and go to the throat and lungs which would result in further complications. I then went to hospital admissions to fill in the necessary paperwork and get authorization from GEMS. This is when this became an issue as when the hospital admin called GEMS they were sent from pillar to post. My daughter (the patient) was asked to answer a security question stated by the consultant. I did not understand why she was asked to produce this response as she was in an immense amount of pain, and we had a member of the staff ready to answer all questions on our behalf. I as a main member I did eventually speak to one of the consultants and answered all questions that were posed to me. Unfortunately, this was a futile attempt as we spent over 3 hours trying to receive an authorization number and, in the end, receiving nothing at all. All the consultants the hospital admin spoke to claimed they did not receive the admission paperwork, which was sent to them 3 times if not more. The hospital suggested that she must be taken to the ward since she was in pain and must be on the antibiotics drip as soon as possible as per the doctors’ instruction, we were advised to deal with the medical aid the following day (25 April 2024). The same day her operation was scheduled for 14:00. Early morning of the 25th my husband and I went to the hospital, and I was informed that no one was willing to assist and provide us with the necessary information and we must call GEMS. I then contacted DENIS and to my surprise I was now informed that the hospital and DENIS Case Managers were supposed to lease each other since this was an emergency case. While I was still on the phone with the consultant, I requested that she transfer the call to the DENIS Case Manager so that he can try and resolve the matter. Unfortunately, he was refused the ability to escalate the matter to the necessary individuals, this caused me some frustration as both the hospital and DENIS are to communicate and find the appropriate way forward in this situation. As a result my husband and myself went to the GEMS walk-in Centre at Arcadia and we were assisted by Precious, and she connected with a Precious from DENIS, who did not provide us with any assistance instead told me to go back home because my case was being dealt with and I was wasting time by talking to her on the phone. This resulted in me losing my temper and making the request to speak to her Team Manager by the name of Mpho (I am unsure if this is the gentleman’s name). The result was an argument between myself and Mpho with him questioning whether the situation was truly an emergency as the operation was not performed on the same day of admission. I then explained the reason as I have on the first paragraph. I requested he send me what he was saying to me via email he bluntly refused to and told me that the calls were recorded, and I was wasting his time. I was extremely furious at this point and asked him if he would like my child to die as the doctor specifically advised that the matter could not be put off any further and needed to be dealt with as soon as possible as the abscess could move to the throat and lungs and my daughter is asthmatic which would be dangerous for her. I proceeded to ask him to communicate to us when the authorization number is available for the hospital to proceed with the operation. He articulated in not so many words that his job is more important than saving a life. The matter stated above proceeded for about 2 hours due to the back and forth, eventually Team Manager from the walk-in came and requested to speak to Mpho. He communicated in an unprofessional manner and was unwilling to converse with his fellow colleague. He was asked for his and his colleagues (Precious) information but he refused to produce that information as she desired to produce a report on the matter and their conduct. The Arcadia walk-in centre manager then said the child should proceed with the operation pending authorization. The operation was done and successful she was then discharged on Friday, 26 April 2024 it was then relayed to us by the hospital consultant who helped us at first that GEMS had sent forth information that authorization was approved. On Monday, the 29th I received a message from GEMS that authorization was not approved, I was shuttered, and I called into GEMS to understand why there such a large scale of miscommunication which resulted in myself and the hospital in being mislead. Unfortunately, I did not receive the answer I hoped to receive, as instructed I called once again 3 days later and I was still left without a response. I then decided to wait for the statement that I received Friday, June 21 stating that the reason that the hospital bill was not paid was because: 1. 1027 Motivation is required from the service provider for this treatment. 2. 9870 Service in hospital not authorised. After receiving the statement I phoned DENIS, to my surprise this time I was told the Hospital is not affiliated with GEMS. I was again told that the reason for the codes 1027 and 9870 the hospital did send the email to Jo-anne Versveld from DENIS but the motivation letter was not attached. Why did the receiver of the email not indicate that there was no attachment?

My question is why did your employees fail to advise and give me such crucial information that was supposed to be communicated to me when my daughter was first admitted in February for her wisdom teeth removal? Why am I only learning about this when I enquire about the bill that you do not want to pay whereas you never communicated such information with me?

I have sent the above complaint expressing my unsatisfactory treatment and being made feel like a *****ster to GEMS unfortunately I have not received any feedback from them since the 16 July 2024.