Ridiculous decision by GEMS

<p>I have been suffering from carpal tunnel syndrome in both hands for a number of years. Being a teacher that writes (marking papers, tasks and assessments) a lot and work on a computer, the symptoms are starting to affect my work. Furthermore, a permanent numbness is developing in both my thumbs. The specialist recommends a Bilateral endoscopic carpal tunnel release procedure on both wrists. On applying for authorization, the procedure was refused by GEMS. Apparently GEMS only pay for the open carpal tunnel release surgery. Open surgery not only requires a longer recovery period, it leaves a larger scar and is more expensive than endoscopic surgery if the procedure is required for both wrists, as in my case. Due to the fact that both wrists need to be done, it means I will have to go for two operations in the case of open surgery. According to the quotations received, open surgery can cost about R 19 209 (R 5 600-surgeon, R 11 603 for hospital and R 2 006 for anaesthetist) per hand. Total cost about R 38 418, I will be away from work at least 3 weeks per operation, that means 6 weeks away from work for both hands. The Bilateral endoscopic carpal tunnel release procedure will cost R 29 800 (R 9 900-surgeon, R17 596 for hospital and R 2 304 for anaesthetist) and both wrists can be done at the same time, R 8 618 cheaper and less than a week away from work. The better procedure is cheaper and will mean less time away from work, but this was refused by GEMS, they prefer the more expensive procedure where I will be away from work for about 6 weeks. This does not make sense! We have appealed the decision, but GEMS still refuse the cheaper option. </p> <p> </p> <p>According to the newspapers the financial reserves of GEMS is lower than required by law, they are also loosing members at a rapid rate. From the above it is very clear that ridiculous decisions are part of the cause. As a government employee we cannot leave GEMS without losing our state subsidy. We would really like to go back to Discovery, but are caught by the rules. I will be consulting my union on moving my medical add without losing the state subsidy!</p> <p> </p>