cW
christa W

1 reviews | Active since Feb 2011

05 Jul 2016, 13:17

POOR POOR SERVICE AND BENEFITS

<p>We app**** for a operation aurthirization more than a month ago. I had to follow up. It was declined BUT SAID ignore the decline sms as it has been sent to the panel of advisors. I followed up again today and just after that got a letter all declined NO REASON.</p> <p> </p> <p>Nice faceless cold paper to decline on reconstruction after mastectomies.</p> <p>Our money of R60 000.00plus a year for many years now worth nothing. Limits exhauseted within months even if you don't go to the Dr often,</p> <p> </p> <p>I am ashamed to say I AM ON GEMS. Look at all the complaints on social media. I am not impressed and I know it will be a joke of just another one moaning nothing serious.</p> <p> </p> <p>I hope nobody will every have to go through this and be treated like I am today.</p>

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Replies (5)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply05 Jul 2016, 13:35
Official

Good day

We are terribly sorry that you have been experiencing difficulties.

We are attending to your complaint and we will provide feedback.

Kind regards

The GEMS Online Team

cW
christa W's update05 Jul 2016, 13:50
Reviewer Update

I just spoken to a helpful lady. All approved now except 0296?Which still does not make sense. I must say her personallity and way she treated me with respect made me to stay calm. I am not going to leave this matter as I want all approve as per the Dr.

Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply18 Jul 2016, 15:21
Official

Good day

Thank you for affording GEMS the opportunity to respond to your complaint regarding authorisation. Please note that this matter has been referred to the GEMS medical advisor for further review.

We apologise for the delay in authorisation and for any inconvenience caused in this regard.

Yours in service,

The GEMS Online Team

Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply22 Jul 2016, 14:37
Official

Good day

Thank you for affording GEMS the opportunity to respond to your concerns regarding authorisation.

As indicated, we are awaiting the motivation from your service provider whom we have contacted. Once we have received the motivation, we will present it to the clinical review committee.

Our sincere apologies for any inconvenience caused in this regard. We look forward to receiving the motivation and presenting it to the committee.

Yours in service

The GEMS Online Team

Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply01 Sept 2016, 16:21
Official

Good day

As communicated, we have made numerous attempts to obtain the letter of motivation without success. Unfortunately, we have to close this query.

We look forward to receiving the letter from your service provider so that me may resolve your query.

Kind regards

The GEMS online team