VB
Veruksha B

1 reviews | Active since Oct 2009

21 Jul 2016, 15:34

NO Designated Service Provider in GP or KZN

<p>My father is unable to walk and is in pain. He has been to an orthopaedic surgeon, scans have been done and the orthopaedic surgeon has advised that my father requires surgery to his spine failing which he will not walk. The orthopaedic surgeon has already advised that GEMS pays 100% whereas he charges 300%. </p> <p>Since 6 July, I have been trying to obtain to details of ANY orthopaedic surgeon whether in KZN or GP who is a GEMS DSP. I have sent emails to various GEMS email addresses but there been no constructive response. I have telephoned and I have been shunted around from customer service to network providers to hospital authorizations. It is evident that that one of the consultants does not even know what PMB stands for. While on the telephone line with a consultant on Saturday, 16 July, she checked both in KZN and GP and advised that there are NO orthopaedic surgeons who are GEMS DSP either in KZN or GP. </p> <p>I have phoned different orthopaedic surgeon to ascertain whether they will accept payment as per the GEMS tariff and it is evident that they charge more than GEMS will pay which means that there will definitely be a co-payment.</p> <p>My father needs the surgery and I have tried to find a GEMS DSP but can’t.</p> <p>I pay R5999 per month towards GEMS. I cannot afford a co-payment.</p> <p>Please advise where my father must obtain this essential treatment that he urgently requires?</p> <p> </p> <p> </p>

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Replies (3)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply22 Jul 2016, 08:28
Official

Good day

Thank you for bringing your concerns to our attention.

We are investigating your complaint and will provide feedback.

Kind regards

The GEMS Online Team

VB
Veruksha B's update25 Jul 2016, 16:55
Reviewer Update

GEMS, how and where should I provide you with my personal membership number? You, are so pathetic that you haven't been bothered to leave a specific contact number and name so that I can reach the specific consultant dealing with this complaint???

Should I call 0 ********** and ask for The GEMS Online Team???

My name and cell number is on this website yet you haven't even bothered to call me and obtain further info.

Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply04 Aug 2016, 13:54
Official

Good day

We sincerely apologise for the delay in responding to your complaint and any inconvenience caused in this regard is sincerely regretted.

We are so sorry to hear about your difficulties in finding an orthopaedic surgeon who is on the GEMS specialist network. Unfortunately the scheme network does not at present include orthopaedic surgeons but we are working hard to change this.

We have in the interim been in contact with your the orthopaedic surgeon with whom your father consulted in order to obtain additional information. We will keep you updated on further developments.

Yours in service

The GEMS Online Team