MEDICAL AID REFUSING TO PAY MY CLAIM STATING THAT IT IS STALE!

<p>GEMS is the worst medical aid scheme ever! I am fed up.</p> <p>My wife was reffered to a gynae by the family doctor as she was pregnant. I took her to the gynae on the 22 Dec 2016, I paid R1400 with my own money. On the 04 January 2017 I sent through the claim to GEMS there was no response whatsoever then on the 25 January 2017 I made a call to find out about the submitted claim, I was then told that it was not paid due to a referral letter that was not submitted. My first question was, what if I never called GEMS, how was I supposed to know that there is a document needed? I then called my family doctor and he scanned the referral letter to me and I forwarded it to GEMS on the 31 January 2017. I received no feed back once again from this terreble medical aid scheme. I waited 3 weeks and I called in then they told me that it has been escalated to the payment department.</p> <p>I waited again and a month went by, I called in to query about the claim, they told me that it was not paid because the referral letter was not visible enough for them to see the PR of the doctor. My question once more, If I had not called GEMS, how was I going to know that they couldn't see the letter?</p> <p>I called the family doctor and requested a new letter, he forwarded it to me. I then called GEMS and asked if I could send in the letter, the consultant agreed and I sent the letter. 3 weeks down the line I called in to query about my money I was told that the claim is stale and it would need them to investigate. I couldn't believe this as it is GEMS that was delaying this whole process because they FAIL TO COMMUNICATE WITH CLIENTS. I asked the consultant who was assisting me and he said he would check the claim and escalate it to payment department and I should check within 7 working days, this time around I asked for a reference, he gave me 150517Q2K3PL (Wonga). I called in after the wait and I spoke to a lady that told me that the claim was never escalated and she would do it, she gave me reference 250517Q2P7VW(Khanyisan) and requested me to send in the documents again, I did exactly that. I then waited days and decided to call in again. I spoke to a lady by the name of Unice on reference 080617Q2WX06(Unice) who told me that the account is stale and there's nothing she can do about it and that I was misinformed by the other consultants that I had spoken to.</p> <p>Who's fault is it? GEMS has *********** staff members that played me for a fool. GEMS is using it's clients to benefit more. Why is my claim not paid but I pay my monthly contributions each month and why can't they assist a client in the correct manner? I used my airtime calling them numerous times for long minutes on the line? My member number ********** 40 and I am highly disappointed in the service offered by GEMS. It is terreble. Most of my colleagues in the department warned me, I guess now I understand why they advised me not to use GEMS.</p>