Payment of items authorised on PMB care plans

During my recent interaction with GEMS I was forced to go onto their formulary drug, which unfortunately requires a blood test every week.

Once approved the GEMS pharmacist phoned me and sent me an updated PMB care plan. I was assured that even should all my pathology benefits be used, payment of items authorised on the PMB care plans would be paid. I was reassured that I had x18 code 3805 and 3806 pathology tests authorised until the end of the year. Guess what the administrator only paid the first lot and gave me a co-payment on the second lot, a clear indication of their inefficiencies once again, not loading or taking into consideration which items are to be paid from the PMB care plans.

The problems relating to my first complaint: short payment on my hospital account from August and pathology account have still not been addressed to my satisfaction only to find new problems cropping up. All of these problems relate to the administrator.

I really hope these complaints will be addressed efficiently now as my only recourse unless resolved going forward is to address these complaints to the CMS.