Rejected claim

I’m so disappointed and very much frustrated with this medical scheme, I can’t believe I’m under so much stress while in my 3rd trimester of pregnancy, in December 2025 I went for my antenatal check up and we did an anatomy scan at 19 weeks and a few days , Gems rejected the claim and only paid for the consultation as they said I should be between 20 to 24 weeks in order for them to pay for the anatomy scan, i understood and settled the remaining balance , I then called the scheme and asked if I can redo the scan as I’ll be in the required gestational week to do the scan according to their policy and the consultant I spoke to ( Jimmy from the maternity dept) said yes as he could see from their side it does show that I was 24 weeks at the time which was the (16 of Jan 2026), the consultant even gave me the code the doctor should use in order for the claim to be processed, the doctor did exactly that as that’s what I told him as that’s what I was advised by the consultant but the claim was rejected yet again, I called the maternity dept and the consultant I spoke to (Mangaliso) asked why did they not pay cause she could see on the system that I was 24 weeks, she then reached out to their claims dept and asked why they did not pay and as usual they came with stories , their reason was that I was 24 weeks and 4 days and they require me to be 24 weeks straight yet that’s not what I was told when I called in, I was told as long as I’m 24 weeks and not 25 weeks , even if it’s 24 weeks and a few days, I made sure to call the scheme and asked if I could redo the scan again and the answer I got was yes but now they don’t want to pay yet I got this advise from their team, I’m honestly so frustrated and my BP is sky rocketing cause they don’t want to pay, why must I always use money out of my pocket while there is a scheme we pay each month, this can not be my responsibility as the consultant told me they would pay and reassured me, as I was well within the required weeks to get the scan, that call can be listened to as I do have the reference number for it , it’s honestly not fair and not right what gems is putting me through, the consultant was very friendly and very helpful and I don’t blame him but the claims dept always finds reasons to come with stories not to pay, I will not pay this doctor as the scheme needs to own up to the advise I got and pay as I did exactly what I was advised