1 reviews | Active since Aug 2014
Medical aid not paying
<p>My 2 year old daughter went for dental proud ure that have to be done in the theatre.Therefore she had to be admitted in day hospital.</p> <p>In January we received a invoice of R11 540 thereof gems have only paid R6023. </p> <p> </p> <p>I am on Gems emerald and How can this proud ure not be covered by Gems in full as my daughter is 2 years old and this procure can not be done under normal circumstances. </p> <p> </p> <p>My gems medical aid number is ********** 83 WE PRETORIUS the invoice is from net care hospital reference nr ********** 288 dated 08/11/2016 .</p> <p> </p> <p>It is ridiculous as we paying a lot but when gems have assist problems must always occur.</p> <p>Like I said how do Gems think that a 2 year old must dental proud ure under normal circumstances </p> <p> </p> <p> </p> <p> </p>
Good day
Thank you for affording GEMS the opportunity to respond to your concerns. We are looking into this matter and will revert soonest.
Kind regards
The GEMS online team
Good day
Thank you for affording GEMS the opportunity to respond to your concerns. We are looking into this matter and will revert soonest.
Kind regards
The GEMS online team
Good day
Thank you for alerting us to your concerns regarding your claim.
Please note that the account was not paid in full due as the non PMB day case limit was unfortunately depleted at the time.
We apologise for any inconvenience caused in this regard.
Kind regards
The GEMS online team
Good day
Thank you for alerting us to your concerns regarding your claim.
Please note that the account was not paid in full due as the non PMB day case limit was unfortunately depleted at the time.
We apologise for any inconvenience caused in this regard.
Kind regards
The GEMS online team
Why do there show transaction to be reversed on statement of gems.
Why do there show transaction to be reversed on statement of gems.
Why tarif code 58081 is only paid nearly half .Inside hospital for theatre is supposed to be paid in full.This matter will be forward to the medical onbuds man for review and all names that were assisting me Wil be named
Why tarif code 58081 is only paid nearly half .Inside hospital for theatre is supposed to be paid in full.This matter will be forward to the medical onbuds man for review and all names that were assisting me Wil be named
Good day
Please note that all activity on your medical scheme profile will always be reflected on your claims statement. This is done to keep you informed of any claims that have been submitted and will allow you to pick up on anything that may be incorrect.
The theatre fees was subject to a non-PMB day case with a limit of R15 034 per beneficiary per annum which was unfortunately exceeded because of previous claims.
We trust this response clarifies why the account could not be settled in full.
Kind regards
The GEMS online team
Good day
Please note that all activity on your medical scheme profile will always be reflected on your claims statement. This is done to keep you informed of any claims that have been submitted and will allow you to pick up on anything that may be incorrect.
The theatre fees was subject to a non-PMB day case with a limit of R15 034 per beneficiary per annum which was unfortunately exceeded because of previous claims.
We trust this response clarifies why the account could not be settled in full.
Kind regards
The GEMS online team