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JG
Jesslyn G

1 reviews | Active since Apr 2019

06 Nov 2020, 08:18

Retracting previously approved claims

I have recently received an email stating that i owe GEMS a significant amount of money.

I had queried this account as i have been paying cash for my dependents medical expenses.

Previously all dependant medical expenses were paid according to previous claims statements.

However, now i have been sent another claims statement and according to these statements, all claims were reversed.

How is this possible when it was previously paid? Since I had been advised of benefits approved, i have used the designated service provider.

This is going against what was said and i have paid for accordingly.

Please find attached proof claims statements that were approved. And now the current claims statement retracting these amounts.

This is a frustrating and unnecessary problem and it should be rectified.

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Replies (1)
JG
Jesslyn G's update06 Nov 2020, 15:58
Reviewer Update

Good day I am extremely frustrated with the services offered by GEMS. I was under the impression that my newborn was covered on medical aid as i am paying the monthly contribution required. About 2 days ago I had received an sms stating that I owe an amount of about R6000. I had queried this but had not received feedback. I had only been sent a claims statement reversing all benefits for my child dependent. I had contacted the office today and I had only been made aware that my dependent had been taken out of medical aid. The reason being is that her birth certificate was not given. I have attached proof that i had requested an extension due to the pandemic and being unwell from my maternity, i was unable to go to home affairs within 60 days to get the documents done. I had been asked to fax through the document which i had done when I had managed to eventually go to a home affairs department that was open considering the pandemic. I am extremely disappointed and concerned about this situation as i am now being told that my child is not on medical aid! If i had to go to the hospital npw for an emergency, i would have npt even known that this was the situation. Please find trailing emails as proof. Please find attached birth certificate, and sms sent to fax through the documentCan this be treated as priority as my child needs to be on medical aid on her birth date.