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ashvillain A

1 reviews | Active since Dec 2016

28 Jun 2017, 13:35

PMB Denied

<p>I have suffered with mental illness for years, and have sought therapy to help me deal with it. I thought GEMS would be better than my last medical aid, who stopped paying for counselling sessions. For that reason I had to stop going.</p> <p> </p> <p>Upon resuming therapy years later, not only did GEMS not pay for a minimum of 15 visits (which I'm told is law), when I app**** for PMB, they denied it, even though they have approved PMB for other people on the same scheme for the same reasons. All they granted me was one visit to a GP, and they said they'd pay for electroshock therapy.</p> <p> </p> <p>What is this, the dark ages? Now I have to pay out of my own pocket, otherwise if I claim off of the medical aid, not just my benefits, but family benefits are reduced to nil, which means that I'm not covered for other things like visits to the dentist, etc.</p> <p> </p> <p>Ideally I would like to have a PMB approved so I can at least have cover on visits to a psychologist when I need it.</p>

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Replies (5)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply28 Jun 2017, 13:50
Official

Good day

Thank you for affording GEMS the opportunity to respond to your concerns. Please send us a private message with your membership number in order for us to assist you.

Kind regards

The GEMS online team

Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply07 Jul 2017, 16:22
Official

Good day

Thank you for alerting us to your concerns regarding your psychologist visits and PMB.

As per our email communication with you, we can confirm that we have contacted your treating doctor to register your medicine on the chronic medicine benefit. The medicine has now been approved.

In addition, 15 out of hospital psychotherapy sessions were approved from the major affective disorders care plan.

We trust the above is in order.

Kind regards

The GEMS online team

aA
ashvillain A's update20 Sept 2017, 13:00
Reviewer Update
So months later, and after submitting most if not all receipts for the year that GEMS said they would cover (Jan - Dec 2017), and they only paid for 2 visits out of all of those, even though there were several receipts. I was under the impression that even though medical schemes say there's a limit to how far you can back claim, that there are exceptions under PMB conditions. GEMS explicitly stated that they would cover 15 visits in the year. Furthermore, they're taking it out of my benefits again, which I've been advised by a medical professional is not right seeing as it's practically the same story as visiting a the******, and then claiming off of medical aid without a PMB). This potentially once again leaves me with nothing to cover GP visits and appointments with other specialists should I need them. I'm not satisfied with this. GEMS should pay for all of those visits that I've provided proof of payment for, and it shouldn't have to come out my benefits.
aA
ashvillain A's update05 Feb 2025, 00:51
Reviewer Update
I need to have lexamil on chronic medication. I lost a family member lately and have been dealing with depression, grief as well as some financial issues so it's costing me money that I have to pay myself for the drug.

I believe I had it on chronic medication years ago but it was taken off due to it being too expensive and GEMS wanted me to take the generic drug. My brother has used both and didn't recommend the generic one.

I also take passival as an anti-anxiety med. Is there anyway we can get that on acute or OTC medication?
aA
ashvillain A's update03 Mar 2025, 19:29
Reviewer Update
I recently visited a psychologist. Can I claim back what I paid from Gems?