RW
Rachel W

1 reviews | Active since Apr 2024

11 Dec 2024, 12:44

Pathetic service delivery from Gems(Claims not scanned and batched months after being submitted)

I have submitted 2 claims on dates 7 October 2024 and on 16 Ictober 2024 to Gems enquiries. It's almost 3 months and my claims sre still is not appearing on the system. I made several enquiries telephonically to Gems regarding the status of processing of my claims. Every consultant just tell me that they will escalate my claim for scanning and batching with different Call Reference numbers provided( MH***; MH***; MH***; MH***; MH***; MH***). Some of the consultants even alluded that they are aware of health care providers who's claims don't appear on the system after being submitted months ago after they complaint.They even indicated that they will escalate to their team leader. It's just strange that nothing is done by Gems management and technical staff to solve Health care providers problems with having their submitted claims scannned and batched if it's a technical problem as they are aware if it. Its like they are deliberately stalling scanning and batching of claims to not make payment before the year is ending.I am totally fedup with this poor service delivery and ignorance of Health care providers problems with claims processing. I have just stopped to provide services to Gems members as I fear I will never receive money due to.me for services rendered.The Gems members pay their monthly premies yet Gems don't want to pay Providers delivering a service to their loyal, paying members. Can more Healthcare providers please report if their claims are not scanned and batched months after submitting it. Can the relevant authorities such as the Medical Healthcare Board please lodge an investigation into why Gems are not processing HCP's claims after submitted months ago.Medical schemes administerd by Medscheme and Discovery process claims maximum 3 days after being submitted and HCP has no need to follow-up on why their claims are not appearing on the system. It is clear that there is no commitment from the Gems team leaders to solve my queries.

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Replies (1)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply11 Dec 2024, 14:18
Official
Good day,

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