REJECTING CLAIMS FOR CANCER PATIENT

AFTER NUMEROUS CALLS AND EMAILS WITH NO RESPONSE FROM GEMS REGARDING THIS MATTER WE SENT AN EMAIL AGAIN.

Good day To whom it may concern;

- In 2016 September we app**** for Prothesis and Bra’s for patient Mrs Mmutlane as she had a mastectomy. - On the 28th December 2016 we received the approval letter from Gems. (LETTER IS ATTACHED). - As we all know that time of December all the suppliers and companies is still closed. - Monday the 2nd of January our suppliers opened and we ordered the patients prosthesis and bra’s. - On January the 4th the order arrived at our practice and the patient came to collect the prosthesis and bra’s. - We invoiced the prosthesis and bra’s on the 04th January 2017. (PROOF OF EDI SUBMISSION ATTACHED) . - On the 15th of January we received a statement from Gems requesting the motivational letter. (GEMS STATEMENT ATTACHED 15/01/2017). - We then resubmitted motivation – same motivation that was sent on the 19/09/2016. (MOTIVATION ATTACHED). - We then contacted the patient after we received the next statement on the 27th January 2017, to let the patient know we are having trouble with this account. - The patient still in remission then tried to sort it out from her side where Gems made promises to her that they will pay account for months. - Tired of empty promises the patient came to see us in May and asked us to assist her to send documents through again and help her to get Gems to pay as they promised in their approval letter, as we could see the stress is taking a toll on the poor patient we agreed to help her. - We phoned and emailed numerous emails but with no assistance. - The patient came to see us again recently stressed out and in tears about this account , while she is still battling with cancer.

PLEASE WE BEG OF YOU TO PAY THIS PATIENTS ACCOUNT AS WE AND THE PATIENT WENT BY THE BOOK AS GEMS REQUESTED TO GET APPROVAL AND WE HAVE ASSISTED GEMS’S PATIENT, WE ASK NOW OF GEMS TO ASSIST AND TAKE CARE OF THEIR OWN CLIENT NOW. THE SERVICE THIS PATIENT IS GETTING IS NOT FAIR. PLEASE PLEASE HELP THIS PATIENT AND TAKE THIS BURDEN OF HER SHOULDERS. SO SHE CAN FOCUS HER STRENGHT ON GETTING HEALTHY.

Please receive attached account please reprocess this account for payment.