Urgent Escalation – Unauthorized Billing Despite GEMS Authorization

I am writing to formally dispute the recent invoices issued to me in respect of MRI services for which I had already obtained prior authorization from GEMS. The authorization number was provided to the doctors office before the service was rendered, confirming that the claim would be covered.

It is entirely unreasonable and unacceptable to receive a bill months later for a service that was pre-approved. The authorization clearly indicated that funds were available, and at no point was I informed that there would be any shortfall or rejection.

I demand that this matter be escalated immediately to management, investigated without delay, and resolved in full. This account must be settled directly with GEMS or the relevant responsible party — I will not be making payment for charges that should have been covered in terms of the authorization.

Should this issue not be resolved promptly, I will take further action, including but not limited to, lodging a formal complaint with the Council for Medical Schemes, seeking legal recourse, and reporting the matter to the relevant regulatory authorities.

Kindly confirm in writing by no later than 5 working days from today the 12th of August 2025 that this account has been corrected and that no further billing will be directed to me. I also require direct contact from a senior manager regarding the outcome of this matter.