1 reviews | Active since Jan 2015
Refund & Claim incompetence
I had a operation on the 3rd June 2022. I phone for pre-authorisation, I received my pre-authorisation. In the same call I get told what my short fall or co payment will be. I confirm the copayment amount with the consultant, he confirms and tells me, once I have paid the co payment and once I have the proof of payment, account invoice from dr i must submit it to GEMS and I will be reimbursed. I stil double check with the consultant he says yes mam you will be reimbursed. Fine. The operation goes ahead. I pay the co payment. I recieved my accounts from drs. Then paid. Had my proof payment and updated account from drs n surgeon. I submit all these documents. I recieved automated responses from GEMS, now I wait. I've been waiting. Until I decide to follow up with GEMS only to find out that apparently they have not recieved my emails. I then provide the reference numbers of the emails and then magically the emails can be found and the claim will be processed. Then on the 5th Aug just after 8am I phone again knowing that GEMS runs a mid month payment so I phone to confirm I will be part of the mid month payment... Friday the 5th i get told the claim was never sent for processing with back office and it was never submitted. I also get told that the amount of my claim won't be paid as it is not due to me. Which is very different to the initial pre auth call info I received. I'd like to know who is the money due to if I made the co payment and I produced my proof of payment and drs accounts. With this I am furious, cause again its my airtime being used to get transferred and put on hold for something I was sure of that was already processed. So I then ask for a supervisor, I get transferred to a apparent team leader named Chantal. She tells me she will go back to the calls and will retrieve the information and will get back to me before end of day Friday 5th. By 3.30 Friday 5th, I recieve no feedback from this supposed team leader. I call back again just after 3.30 to follow up, seeing as GEMS employees don't stick to their word of communication with us. I call back, the new consultant again tells me there is no email trail, I give her reference numbers everything, she says, the claim was never escalated and they still sorting it out. And she can't put me in touch with Chantal. But she will process the emails again and that's that. Monday 8th I call again as I am going to keep on GEMS for my money. What seemed to be a very competent gentleman tells me, the claim has not been sent to back office. But he will do it and I will be part of the mid month payouts. He also works the refund amount out for me on the phone. And tells me just for safety sake I should resubmit the paper work.... so i do that. I feel confident that he has confirmed my claim, his sent it to back office, he gave me the day I'll be paid and confirmed my amount more or less. So... Friday mid payout comes... 12th Aug... I receive no payment. I recieved absolutely nothing. Instead since the 9th Aug I recieved SMS's saying my enquiry is being processed. WHY IS SOMEHTING STILL BEING PROCESSED WHEN ON THE 9TH AUG I WAS TOLD IT WAS PROCESSED AND I WILL GET MY MONEY. So I'm fed up. I'm fed up that I now have to use airtime again to contact GEMS, on Monday. I have to explain myself again, I have to have the same repetition of everything, I have to resubmit emails that I have reference numbers for. Do I have to wait to now be part of the month end payouts because of GEMS incompetency? I was told 1 thing and now I have to wait even longer. I have followed up. I have called... to no resolution. And for a fine cheek, the apparent team leader is still getting back to me. I WANT MY MONEY. I don't see why I have to wait till month end to receive what is rightfully mine. And why I have to wait longer even though i was told Friday past I'd be paid. I am wanting my money before month end like I was told. I also want the call recordings and I have my email correspondence, as I feel this is a matter for the ombudsman to deal with. GEMS PAY MY MONEY BACK and a suggestion would be to get yourselves COMPETENT AND KNOWLEDGEABLE consultants who actually know what they saying and what they are doing. I require my money, times are tough can't still be fighting and phoning you people for what's mine
Contact: ***
Member no: 00***
I.D.: *** 089
I will not have a positive review until I get my money and this issue is resolved.
Contact: ***
Member no: 00***
I.D.: *** 089
I will not have a positive review until I get my money and this issue is resolved.
