KG
Kelly G

1 reviews | Active since Oct 2014

17 Dec 2018, 19:28

Too long to review claims

On 5 November I emailed proof that blood tests done in April were resubmitted in May to be reprocessed under the maternity program, thus proving that it was NOT a stale claim. To date, after numerous calls by myself to follow up, I keep getting told the claim is still being reviewed. In the interim I have been handed over to ITC for this outstanding account - NOT IMPRESSED!! I can’t understand how a claim takes this long to be reviewed?!?! How many more times do I still need to call, e-mail and escalate the claim before it is settled.

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Replies (2)
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply18 Dec 2018, 10:30
Official
Good day

Thank you for giving us the opportunity to respond. We are looking into this and will respond as soon as possible. 

Kind regards
The GEMS online team
Gems (Government Employees Medical Scheme)
Gems (Government Employees Medical Scheme)'s reply21 Jan 2019, 10:22
Official
Good day

Thank you for alerting us to your concerns regarding your unpaid accounts.

Please note that your case was referred to the claims department who confirmed that only tariff codes 3755, 3932, 3764 and 3949 were approved on the maternity care plan. 

The claim has been reprocessed accordingly from your maternity benefit and will be settled with claims run of 1 February 2019.

We apologise for any inconvenience you may have encountered.

Kind regards

The GEMS online team