Unable to get authorisation without a valid reason while being in severe pain and in need of medical attention. Consultants didn't try to resolve the issue.

On the 18/6/19 I went to see my Specialist as refered by my General Practitioner. I'm currently experiencing a huge amount of pain and is really sick. After the examination the Specialist told me that I need to be admitted as he needs to see me in theatre. His receptionist called Gems (Emerald option) for authorisation. They denied and told her that I'm placed on a waiting period. I've been a member since 1/12/2018 and doesnt have this matter as an acute or chronic condition and therefor shouldn't be having any waiting period longer than 3 months.

I've called Gems various times to try and get a solution or a valid reason for the above mentioned situation. During the first call case number: GEM*** the consultant told me that the problem lies with the diagnoses. I then asked him why and his reply didn't make sense what so ever. When I told him this he changed his story and said no, the problem lies with the procedure. I asked him what's wrong with the procedure and whether it's and exclusion. He said no it's not an exclusion and couldnt tell me what the problem is.

The consultant I spoke during my second call couldnt explain to me why I've been denied auth as he clearly stated that according to the system there's no waiting period on my profile.

The 3rd and 4th consultant I've spoken to both said that the request has been sent through to the underwriters and that I need to wait 4 - 7 working days for a reply. I explained to them that I can't wait that long due to the severity of the pain and that I need to be in theatre by the 20th. I asked if I could please speak to a manager but they both refused and just kept on saying that I just need to wait 4-7days without being able to give me a valid reason/explination. The lady told me that patients that were involved in severe motor vehichle accident also have to wait 4-7 days for auth. I find this totally unacceptable and reckon we could might as well be without any medical aid coverage!

We as members pay our monthly contributions every month on time but as soon as we are in desperate need of medical attention, there's no help what so ever.

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