M***-ill treatment

I am writing this complaint with the greatest disappointment of how GEMS has been treating me as an oncology patient. I am a dependent on my spouse's medical aid M*** and I have been added with effect from 01 July 2024 coming from another medical aid which membership ended 30 June 2024. I was placed on a 3 months general waiting period due to the fact that I am coming from an "external scheme" however was assured that "PMBs" will be covered while I am on the general waiting period. I am an oncology patient for over 11 years which my previous medical aid had been covering for all treatment (Consults, blood tests and chemo) uninterruptedly until the end of June 2024 when I terminated my membership with the scheme

I started experiencing a lot of difficulties since inception with GEMS where I have been struggling to be registered on the Oncology program from the 15 July 2024, I eventually received an authorization number on 01 August 2024 assuming that all is in order since I have received the authorization number.

I made a follow up call after receiving the authorization number on 02 August 2024, to find out what will be the process going forward as I need to obtain my monthly supply of chemo drugs. I was informed that I needed to wait for correspondence from the medical advisor or case manager and after receipt of the correspondence I can go ahead and make arrangements of obtaining my monthly medication. (I don't know who is responsible for generating this correspondence). I made another follow up call again on 07 August 2024 after the turn around time allocated had lapsed, the agent confirmed that they are still waiting for the medical advisor to generate the correspondence for the Chemo drugs and I should be receiving the correspondence Friday 09 August 2024 the latest. I requested that I should be called back and that did not happen. In frustration again I call the department and I landed to a very dismissive agent (Faranaaz)where I was expressing my frustration and she was not showing any empathy for someone who is trusted to work in a delicate department, she sounded like she wanted to get over and done with the call. I felt like I was speaking to a robot with no human element and she was very condescending.

Having to deal with the frustration of not having any medication due to administrative delays from GEMS side and now we have to deal with cold hearted employees. I do not understand what is taking so long in generating a simple letter of approval for a patient to obtain their medication. I feel like there is very little sense of urgency and cancer being a dread disease needs to be treated with urgency and delicacy it deserves but with GEMS that is not the case. A simple letter from the medical advisor has had me defaulting on my medication and who knows that my condition has not deteriorated due to the insensitivity and lack of urgency from a medical aid that we trust with our lives.

How much longer do I still have to wait to obtain my medication or do you need to first lose a patient in order for your employees or medical advisors to do what they need to do when they need to do it. The numerous calls that I have been making since July should be sending a message to your internal department that this case is urgent but it seems like it is just a tick box exercise from your side. What does GEMS want to see happening to me as a patient living with a dread disease The amount of emotional stress stress this caused is impeccable.

I hope this will receive the highest attention Siphokazi *** ***