PMB benefits

My daughter has been diagnised with Lupus SLE 10 years ago which is classified as a PMB illness

1) Her specialist wrote numerous reports about medication and procedures that she need and Gems does not want to pay 2) GEMS disapprove that she see her specialist every three months which directly caused her to lose the function of her one kidney 3) GEMS disapproved her cholesterol medicine 4) She had THREE heart attacks in July which results in 2 stents placed in one of her veins. The cardiologist wanted to do a heart bypass but could not harvest any of her veins due to the fact that they are all damaged by the LUPUS 5) She must now also see her cardiologist every three months so that he can monitor the other veins to her heart to prevent another heart attack 6) Due to all of this she only have 40% function of her heart left 7) Her nephrologist must do tests every time he sees her to see what the function of her one kidney is 8) She must test her INR every week 9) The cardiologist must do an EKG to see what the function of her heart is 10) If GEMS allowed the specialist to see her every three months and allow him to do the tests her health would have been a lot better and the cardiologist would not be necessary 11) Although her illness is classified as PMB and she is registered as such we must pay all this extra bills which could have been prevented out of our own pocket 12) She must now see 2 specialist and yet GEMS only allow her to se one specialist every six months 13) What do GEMS wants us to do? Hospitalise her every time for the tests??? 14) We go to our branch but they cannot helps us just say that that is the rules 15) For her six week follow up visit to cardiologist we have to pay about R2200,00 16) I wrote emails but no response

Hopefully this message will get some response