SM
Sindisiwe M

1 reviews | Active since Sept 2013

23 Jan 2019, 23:47

Pathetic service from Gems - Declined hospital preauthorisation

Gems proving poor service yet again! My daughter collapsed at school on 22 Jan. She was taken to her GP who referred her to the hospital as she was unresponsive. This incident happened around midday and she only regained consciousness around 4 that same afternoon. To my utter dismay, I received an sms from Gems today (23 Jan) telling me that authorisation for her hospital stay has been declined citing that she was still in a waiting period. What waiting period? Just because by some unfortunate stroke of luck she happened to have her first seizure over 10 months after joining Gems? She has never been diagnosed with epilepsy. She has never been treated for anything remotely related to that. She has only ever been to a doctor for colds and throat infections. Never in our wildest dreams did we ever think she would be epileptic! What investigations did Gems do that make them assume that this is a preexisting condition? Epilepsy can be diagnosed at ANY age. This is highly unacceptable! I WILL be escalating this if need be.

0
Replies (2)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply24 Jan 2019, 10:04
Official
Good day

Thank you for affording us the opportunity to respond. We are looking into this and will provide feedback as soon as possible. 

Kind regards
The GEMS online team
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply30 Jan 2019, 14:36
Official
Good day
 
Thank you for affording GEMS the opportunity to respond to your concerns regarding your unpaid account.
 
Please note that the authorisation was not declined, it was pended as is the case for new members/dependants.
 
The case was referred to the underwriters for review. The outcome from the underwriters was that the dependant in question has no condition specific waiting period related to this condition (Epilepsy) and authorisation was therefore approved and released.

The account has been reprocessed and will be settled with the next claims run on 1 February 2019.

We apologise for any inconvenience caused. 
 
Yours in service, 
The GEMS Online Team