Shocking service!

<p>I often deal with medical aids, being a practice administrator. The service I receive from GEMS has consistently been shocking. The poor people at the call centre try their best, but they are not the main problem.</p> <p>I have sent various emails to GEMS, and most of the time it gets lost (no-one knows about it, even though I can prove sending it). Other times they don't bother to read the email properly and just give a **** standard answer that all says the same, and proves that they don't bother to read properly.</p> <p>I also struggle with them providing PMB's. One example:</p> <p>A patient was allowed only 5 PMB sessions for psychotherapy, and then Gems needed a motivation from her GP before they would give 10 more PMB’s... How can a GP be more qualified than a Clinical Psychologist to give a psychological diagnosis??!! When finally she received 10 more PMB’s, she came to see her psychologist again, and we submitted the claim. GEMS somehow missed that she had PMB benefits, and took the last bit from her MSA, which didn’t even cover the full consultation rate (which is below medical aid rates). So both the Cinical Psychologist and the patient lose out because of GEMS' bad service. I then spent a long time on the phone with GEMS, trying to rectify this. They admitted it was taken from the wrong benefits, and said all they can do is to now put it up for review, which means we can only follow up after 21 working days (!) for that is how long it takes to review something. And please note: WE can follow up, not "THEY will come back to us". They also didn’t receive, or couldn’t find, the 2nd claim for this specific patient, even though I have proof of sending it! And this is just for one patient. I have many more examples.</p>