NON PAYMENT OF PMB CLAIMS

<p>Member Number ********** 86, MAIN MEMBER R. BURGESS PATIENT - L Burgess My granny 88 years old was admitted into melomed gatesville from 12/07/2016 discharged 04/08/2016 ICD 10 CODES J18.9 / A41.9/ I 10</p> <p>Her primary way of getting in food is via PEG FEED which was inserted during her stay , now they will not assist with ensure , this is a state pensioner earning R1500 and let alone medication declined after the request by a specialist for chronic medication as its not on the formulary , Lasix , Ecotrin , peploc, purata, we need to pay cash for this , i sent GEMS an email with there statements attached asking them to re look at all accounts with gems reason codes code 175 / 870/278/9505/ Limits exceeded in hospital , This is a PMB level of care the person would have received the same care at a state facility , my gran is bed ridden , cannot walk , talk or go to toilet herself, Please can SOMEONE look at whats going on, Gems just does not reply shotfall of R32 000 For PMB condition this is **************** , if one does not understand PMB they get away with cheating members out of paying the full claim , Hopefully they think of HELLO PETER as a better way of getting heard</p>