Still Not resolved after Furnishing all proof to Gems all documents it states no Payments needed! I now get Delivery has failed to these recipients or groups: Carlo Titus (***) Your message can't be delivered because delivery to this address

To who it may concern. Still no positive response regarding the below matter the consultant that was assisting me with this matter his e-mail is suddenly not working can any one assist me with this matter urgently I Have sent all documentation including motivation for the C section and the Documentation that states no payment needed Gems has messed up initially and now refuses to pay the service provider.

Its has been almost 2 years now and I am having the most difficult time with Gems Government employment Medical aid scheme. They refuse to pay for the delivery of my baby at Mediclinic Midsteam! I am a personal assist in a government organization and extremely cautious when it comes to handling matters with importance. I did call Gems prior to my delivery and had my doctor motivate the delivery and I have proof that Gems has said there are no Payments or co payments needed by the member. I been calling to the call center to follow up i spend minimum 30 mins on the line when i get trough I explain my situation and suddenly the call gets cut by the call center agent. Finally after spending hours on the line spending R100s of Rands on airtime I get a simple answer that they will look into it which doesnt help me as I now have a bill of more than R14000 to pay and Lexmed continuously calls me harassing me for the money that I do not have and am not liable for. I also have voice recordings of this. If there is some one on this forum that can assis me I will be entirly greatful as I am at wits end and have exausted all avenues. I even tried last year November to down scale my medical aid plan I spent an entire day at the gems offices in pta. To lower my plan from Emerald +- R9000 to berly to a lower amount so I can at least be able to live.Gems have refused couness times to assist I have trails of emails with no response....How can a Medical aid treat their members with such unreliable service even after receiving authorisation and approval of my delivery.

Very Dissatisfied and disgusted by the pathetic service.

MRS ROWENA REDDY 60 EMARALD CLOSE ECO PARK ESTATE BOX 302 CENTURION 0157 05 October 2017 Dear MRS ROWENA REDDY Approval/Partial Approval of Request This Authorisation is only valid for the specified beneficiary, accommodation level and codes and is dependent on active membership (this excludes suspended membership) and the available benefits. When approving the authorisation GEMS first checks the sub-limits and benefits that are available at the point of request. An approved authorisation is not a guarantee that GEMS will settle the bill in full. It is important to contact the GEMS Hospital Authorisation department in the event of changes; i.e. The date of service/ admission date, length of stay/ required to stay longer, level of care or if there is additional treatment required after the original authorization was approved. Please note that should the patient's stay be extended, GEMS requires an appropriate clinical motivation from the treating service provider, should these not be received the Scheme may decline funding/ paying of the change or additional treatments done after the authorization was approved. Items appearing on the "Medscheme Health Risk Solutions In-Hospital Restricted and Non-Covered Services" list are not covered by this authorisation. Patient name: MRS ROWENA REDDY Member number / Dependant code: ********** 03/00 Scheme and Option: GEMS, EMERALD Authorisation number: ********** 0 Admisson number: L ********** 255 Reason for admission: CAESAREAN DELIVERY ONLY Treating provider: MATHONSI N W AND NKOSI B S S Place of treatment: MEDICLINIC MIDSTREAM

Co-payment applicable: R 0.00

Length of stay: 3 Days Admission date: 06/03/2017 Expected discharge date: 09/03/2017 Accommodation required From: To: C-section first day including prolonged labour 06/03/2017 AM 07/03/2017 AM C-section subsequent days 07/03/2017 AM 09/03/2017 AM Code Outcome Description 59514 CPT Approve CAESAREAN DELIVERY ONLY O34.2 ICD MATERNAL CARE DUE TO UTERINE SCAR FROM P Z37.0 ICD SINGLE LIVE BIRTH 2615 NRPL Approve GLOBAL OBSTETRIC CARE: ALL INCLUSIVE FEE FOR CAESAREAN SECTION AND OBSTETRIC CAR O82.1 ICD DELIVERY BY EMERGENCY CAESAREAN SECTION