NO SERVICE

It has been two months short of a year since my last complaint to GEMS on Hello Peter, during which time I have been trying to resolve an exgratia issue for my client. Client received an apology from GEMS for the initial error that was sent to the member in 2017 that her son "did not qualify" for specific chronic medication that was specifically listed on the 2017 and 2018 formulary and all motivations had been submitted to GEMS (we had to resubmit the motivations on a couple of occasions even though they had been sent to GEM, constant follow up and absolutely NO assumptions that documentation had been received by GEMS irrelevant that it had been forwarded from Drs. main member and myself) but no approval was done, it took a year to get the medication covered! So now we are working with the exgratia since the medication was approved around August 2018, (we are going on eight months working with this claim.) . Member had to fund the medication in 2017 herself due to GEMS not completely and fully working with the information they had on system, info that was sent by Dr., me and member. Upon submitting all additional information that GEMS required for the Exgratia, GEMS messed up and cancelled the exgratia application as the medication had now been approved! We had to re explain that the exgratia application was not for the approval of the medication, it was to recover the costs of the medication that the member had to fund herself in 2017. GEMS had to re-open and resubmit the exgratia application for decision from the committee, which have meetings during the year, next meeting was January. January came and feedback from meeting was additional information requested (scripts, accounts from pharmacy etc). Submitted additional information to GEMS and we were advised that this was ALL the information that they required. GEMS submitted to committee for next meeting in June (missed the February meeting). June meeting has taken place and exgratia has been declined "Managed Care information required"?. We are two months short of a year.................!!! Is it not simple logic that if something was previously supposed to be approved and was not, due to a GEMS error, an apology given to the member for not previously approving and advising the member to apply for exgratia, that it should be a simple refund to the member , nothing complicated? Gadija, you gave me your email address yesterday and the mail is bouncing back as incorrect. I have tried to call you on numerous attempts yesterday and today but no one is answering. This matter needs to be resolved immediately. If not we will be taking up the matter with the Council for Medical Schemes.