SM
Siphiwe M

1 reviews | Active since Oct 2015

06 Dec 2016, 11:31

REFUND FOR OUT-OF-NETWORK DOCTOR STILL NOT PROCESSED!!!

<p>On the 25th of May 2016 i went to a out-of-network Doctor and had to pay the Dr's bill cash. When claiming for my refund, since this was the 1st time using a out-of-network Dr, I submitted all documentation that were requested from me. which is Proof of payment and Latest settled Bill/Statement from the Dr showing I paid. I did that and was given a Ref no. 1810QXJWT2. </p> <p>I did not receive any corespondence from GEMS whatsoever after this. I then called in and all call centre agents kept promising me that it has been sent for approval, and I kept being sent back and forth between the Claims Department, Client Service Department, and the Berly Department with all agents telling me the same thing then transferring me to the next agent, which non colud really help. I called today and NOW they tell me my claim for refund was rejected because I ommited some ICB-10 (I dont know what this is). This was never requested of me at first, and no correspondence has been done till today.</p> <p>I am really tired of this duck and dive "game" played by Gems. I submitted the proof of payment CAN I JUST GET MY 80% REFUND!!! </p> <p>or atleast be contacted by someone who knows what they are doing and we solve this!!</p>

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Replies (2)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply06 Dec 2016, 14:12
Official

Good day

Thank you for bringing your refund concerns to our attention. We are looking into this matter and will provide feedback as soon as possible.

Kind regards

The GEMS online team

Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply13 Dec 2016, 16:31
Official

Good day

We regret to inform you that the refund for services rendered on 26 May 2016 cannot be processed for refund as the account is now almost seven months old and is classified as being stale.

The Scheme has raised a number of queries regarding this account with your service provider as well as with yourself. Our last unanswered enquiry was raised on 26 July 2016.

We are unfortunately bound by strict statutory timelines and trust you will understand why we are unable to assist.

Kind regards

The GEMS online team