1 reviews | Active since Jun 2016
No Authorization for Wisdom Teeth Removal
<p>My husband has been to the Maxillo-Facial and Oral Surgeon (GEMS does not have any on their list and also cannot reccomend any one for us) in Germiston and the doctor told him that he has to have all 4 wisdoms removed and that it CANNOT be done in the chair, but has to be done under anaestetics in a hospital.</p> <p>GEMS is fighting with me about why he needs to do it in a hospital - the doctor wrote a letter of recommendation and sent the X-Rays as well but now their excuse is that the want to know how severe the pain is etc.</p> <p>Seems like they are dodging their responsibility to cover their members for surgeries like this, since we have a friend who has had her wisdoms removed under anaestetics. They have the doctors reasons for the surgery as well as the X-Rays. My husband is in severe pain and they still find reasons to avoid giving authorization. </p> <p> </p> <p>We are trying Hello Peter now, our next step will be the Council For Medical Schemes.</p> <p>We would appreciate a speedy reply </p>
Good day KeshDeepak,
Thank you for affording GEMS the opportunity to respond to your concerns.
A GEMS consultant will contact you shortly to provide you with the necessary assistance.
Please allow us a little time to investigate your complaint. In the meantime, please also send us your membership number in the meantime.
Kind Regards,
The GEMS Online Team
Good day KeshDeepak,
Thank you for affording GEMS the opportunity to respond to your concerns.
A GEMS consultant will contact you shortly to provide you with the necessary assistance.
Please allow us a little time to investigate your complaint. In the meantime, please also send us your membership number in the meantime.
Kind Regards,
The GEMS Online Team
Good day KeshDeepak,
Thank you for the opportunity afforded to GEMS to respond to your concerns. We are terribly sorry to hear that you experienced difficulties in obtaining the necessary approvals.
Your request for authorisation, as received by the Scheme on 26 April 2016, was initially declined due to a lack of the necessary information. Following receipt of your complaint the case was however reviewed and the necessary supporting documentation was obtained from your treating doctor.
Your outstanding account for services rendered 20 April 2016 has since been accepted for payment and will be settled at Scheme rates and in accordance with your available, remaining benefits on 1 July 2016.
We trust that the above is in order and have sent you the necessary documentation including the authorisation letter.
Please remember that authorisations are often held back due to a lack of motivation on the part of the doctor. It is therefore a good idea to ensure that this is attended to at the outset.
Yours in service,
The GEMS Online Team
Good day KeshDeepak,
Thank you for the opportunity afforded to GEMS to respond to your concerns. We are terribly sorry to hear that you experienced difficulties in obtaining the necessary approvals.
Your request for authorisation, as received by the Scheme on 26 April 2016, was initially declined due to a lack of the necessary information. Following receipt of your complaint the case was however reviewed and the necessary supporting documentation was obtained from your treating doctor.
Your outstanding account for services rendered 20 April 2016 has since been accepted for payment and will be settled at Scheme rates and in accordance with your available, remaining benefits on 1 July 2016.
We trust that the above is in order and have sent you the necessary documentation including the authorisation letter.
Please remember that authorisations are often held back due to a lack of motivation on the part of the doctor. It is therefore a good idea to ensure that this is attended to at the outset.
Yours in service,
The GEMS Online Team