1 reviews | Active since Feb 2018
Terrible services from GEMS SURGICAL APPLIANCE DEPARTMENT AND HUGE TIME DELAYS, POOR COMMINICATION
Terrible service from GEMS CALL CENTRE Agents.
I call weekly. They can't view documents you email to them.
They can't view documents they email to you approving your claim.
Then they don't know anything, they can't find documents on the system.
Call Centre Agents admit they can't even get hold of the SURGICAL APPLIANCE DEPARTMENT.
Then you are told there is a 8 week delay in correspondence from SURGICAL APPLIANCE DEPARTMENT.
So you don't receive any feedback.
They ask you to resubmit motivation and invoices, which you do numerous times.
GEMS finally approves claim, but still does not pay and they request another invoice.
There is no clear communication.
In the interim 3 months lapse.
And GEMS has no accountability, no dispute process you can follow. The Call Centre Agents will not send you anything in writing. I have called numerous times.
And still GEMS has not reimbursed me for two assisstive devices I have purchased cash for my 82 year old mother, pist hospital discharge in Sept 2022.
So the saga goes on.
One needs to investigate medical aid processes, and the qualifications of the staff, as well as turn around times for written responses on claims decisions, as they communicate after 4 to 6 weeks.
When such times has lapsed they will call your claim and "stale claim".
Why are GEMS such a dishonest unaccountable medical aid, with poor official communication processes.
Someone needs to investigate. GEMS..... Metropolitan Holding Group...
Claims Assessment Procedure.
I have done an online complaint to Medical Aid Schemes Ombudsman..... However unable to obtain a resolution number from GEMS, because you are not allowed to escalate to a Team Leader or Manager.
Advice required on this process.
How does one escalate a complaint to GEMS CLAIMS DEPARTMENT.
IF YOU email ***, you will get an automates response email. And you will get a response weeks later, if you are lucky.
2. Will print official responses from GEMS 4 to 6 weeks later.
3. Will take screen ****s if when I resubmitted documents, I.e. Letter of motivationdated September.and new invoices which Dischem staff were professional & kind enough to do. However the tax invoice will not match the date of the items purchased in September, as GENS requested a tax invoice with nappi codes 4 to 6 weeks later
4. Also obtained tax invoice from Mobility solutions with practice number and nappi codes. Also resubmitted to GEMS via email.
5. Received response from GEMS approving items, but GEMS is still requiring another invoice.
6. How many invoices of the two assisstices devices must I submit. In which time months are lapsing by as GEMS. only communucates after 3 to 6 weeks.
How is this a stale claim. When GEMS communucates after weeks.
SOMETHING SERIOUSLY WRONG WITH THEIR TURN AROUBD TIMES.
THEY CREATE A SITUATION SO THAT THEY DON'T HAVE TO HONOUR A CLAIM.
They did oat a claim for the physio my mom received during her hospital stay dates 11,12, 13Sept 22 as the ICD 10 code submitted by ortho and physio was incorrect. Physio a mended ICD 10 code, claim paid to service provider last week Friday.
However shockingly my ckasim for the 2 assusstive devices purchased after mons discharge in Sept 22 is suddenly a stake claim.
GROSS INCONSISTENCIES IN CLAIM ASSESSMENT PROCESS.
Service providers cvkaims are paid 5 months later.
But my claim stating it was approved 14 December 22 still unpaid.
U professional, inconsistent, ********* conduct.
Complaint will be faxed with proof to Medical Aid Schemes if South Africa Ombudsman. Filled on link be complaint today.
I will not let this just go. GEMS ARE IRRESPONSIBLE.
MY complaint was supposedly escalated sith a reference number, I was told a Manager would call me back.
If course no one called yet.
This was expected.
2. Will print official responses from GEMS 4 to 6 weeks later.
3. Will take screen ****s if when I resubmitted documents, I.e. Letter of motivationdated September.and new invoices which Dischem staff were professional & kind enough to do. However the tax invoice will not match the date of the items purchased in September, as GENS requested a tax invoice with nappi codes 4 to 6 weeks later
4. Also obtained tax invoice from Mobility solutions with practice number and nappi codes. Also resubmitted to GEMS via email.
5. Received response from GEMS approving items, but GEMS is still requiring another invoice.
6. How many invoices of the two assisstices devices must I submit. In which time months are lapsing by as GEMS. only communucates after 3 to 6 weeks.
How is this a stale claim. When GEMS communucates after weeks.
SOMETHING SERIOUSLY WRONG WITH THEIR TURN AROUBD TIMES.
THEY CREATE A SITUATION SO THAT THEY DON'T HAVE TO HONOUR A CLAIM.
They did oat a claim for the physio my mom received during her hospital stay dates 11,12, 13Sept 22 as the ICD 10 code submitted by ortho and physio was incorrect. Physio a mended ICD 10 code, claim paid to service provider last week Friday.
However shockingly my ckasim for the 2 assusstive devices purchased after mons discharge in Sept 22 is suddenly a stake claim.
GROSS INCONSISTENCIES IN CLAIM ASSESSMENT PROCESS.
Service providers cvkaims are paid 5 months later.
But my claim stating it was approved 14 December 22 still unpaid.
U professional, inconsistent, ********* conduct.
Complaint will be faxed with proof to Medical Aid Schemes if South Africa Ombudsman. Filled on link be complaint today.
I will not let this just go. GEMS ARE IRRESPONSIBLE.
MY complaint was supposedly escalated sith a reference number, I was told a Manager would call me back.
If course no one called yet.
This was expected.