MM
Matlhodi M

1 reviews | Active since May 2018

05 Jun 2018, 07:58

The unfair delay by Gems medical aid to pay the doctor

I had a surgery on 17th of November 2017 at a gynaecologist.I was given a statement of R1722.97 amount I was supposed to pay part and the other portion was supposed to be paid by Germs Medical Aid. Germs repudiated the claim firstly on the 12th March 2018 when i called and was advised of same because there was no practice number on the statement on which there was. i resubmitted the claim with the exact number and statement. The claim was again rejected and this time I was advised that there is no duration of the surgery on the statement of which there was .i advised that her claim will be reassessed and payment will be made month end . My account is about to be handed over by the gynaecologist's office.Germs was supposed to pay R7000 now because of their delay the amount has increased to R8000.00 Please I need help

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Replies (2)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply05 Jun 2018, 08:35
Official

Good day

Thank you for affording GEMS the opportunity to address your concerns. We are looking into this matter and will provide feedback.

Kind regards

The GEMS online team

Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply13 Jun 2018, 15:11
Official

Good day

Thank you for alerting us to your concerns pertaining to an outstanding account.

As per our correspondence with you, the service provider fees are in excess of Scheme rates and the benefits the member has received are correct.

We have sent a request to your service provider for further information and upon receipt of this information, the account will be reviewed.

We look forward to receiving the information so that we can finalise your enquiry.

Yours in service

The GEMS online team