1 reviews | Active since Feb 2017
Violation of Human Rights and Access to Mental Health Care
<p>I am a member of the Government Medical Aid Scheme. I have been undergoing long term treatment with an educational psychologist for seven years. I was referred to her by a clinical psychologist. GEMS have previously covered my treatment. However my most recent claim statement was rejected as GEMS will no longer fund the services provided by educational psychologists. GEMS have forced me into a situation where I have to terminate my treatment. This negatively impacts my health. According to the Medical Schemes Act, medical aids do not have the legal mandate to discriminate against sub disciplines of psychologists. The scope of practice for psychologists was promulgated in 2011. GEMS covered the services rendered by educational psychologists after this promulgation. There have been no changes to the scope of practice since 2011. The sudden decision to stop paying educational psychologists is thus senseless and contradictory. No consideration has been given to members who are currently in treatment and rely heavily on these services for chronic and other conditions. The treatment and diagnosis of mental disorders falls within the scope of practice of educational psychologists as pronounced in legislature. GEMS do not have the legal mandate to define, interpret or challenge this document.</p> <p> </p>
Good day
Thank you for giving us the opportunity to respond to your concerns regarding your claim.
We are looking into this matter and will provide feedback.
Kind regards
The GEMS online team
Good day
Thank you for giving us the opportunity to respond to your concerns regarding your claim.
We are looking into this matter and will provide feedback.
Kind regards
The GEMS online team
I submitted a formal complaint to GEMS 3 weeks ago. I have sent 6 follow up emails since my initial complaint. GEMS has not responded to any of these emails. I also sent GEMS Circular 34 of 2011 sent out by the Council for Medical Aid Schemes in response to the rejection of claims by medical schemes and administrators from some category of psychologists. This circular is very clear that the Medical Schemes Act does not confer upon medical schemes any legislative authority or mandate to adjudicate on the scope of practice for psychologists.
I submitted a formal complaint to GEMS 3 weeks ago. I have sent 6 follow up emails since my initial complaint. GEMS has not responded to any of these emails. I also sent GEMS Circular 34 of 2011 sent out by the Council for Medical Aid Schemes in response to the rejection of claims by medical schemes and administrators from some category of psychologists. This circular is very clear that the Medical Schemes Act does not confer upon medical schemes any legislative authority or mandate to adjudicate on the scope of practice for psychologists.
After posting a complaint on hellopeter.com this afternoon I received two phone calls and one email from GEMS. The first caller said she was reading my letter of complaint (as we spoke) and was putting me through to her supervisor. Her supervisor told me not to repeat my story as he has it in front of him. He said GEMS had emailed me a letter of reply but did not attach the letter to their email. I therefore did not get it. The second caller said they could not trace my complaint because my initial letter of complaint did not state my membership number (I note that my initial letter stated my membership number very clearly under a heading "for your reference".). Then, the email I received after these two phone calls said "with reference to your complaint there was no letter attached to it. We request that you resend". I am afraid this does not install faith in GEMS handling this case...
After posting a complaint on hellopeter.com this afternoon I received two phone calls and one email from GEMS. The first caller said she was reading my letter of complaint (as we spoke) and was putting me through to her supervisor. Her supervisor told me not to repeat my story as he has it in front of him. He said GEMS had emailed me a letter of reply but did not attach the letter to their email. I therefore did not get it. The second caller said they could not trace my complaint because my initial letter of complaint did not state my membership number (I note that my initial letter stated my membership number very clearly under a heading "for your reference".). Then, the email I received after these two phone calls said "with reference to your complaint there was no letter attached to it. We request that you resend". I am afraid this does not install faith in GEMS handling this case...
40 Days later and my complaint has not been resolved. I refer to your reply above which states "we are looking into this matter and will respond"
40 Days later and my complaint has not been resolved. I refer to your reply above which states "we are looking into this matter and will respond"
Good day
Unfortunately GEMS do not reimburse educational psychologist consultations. We are at present awaiting the outcome of a Court ruling on this subject.
Kind regards
The GEMS online team
Good day
Unfortunately GEMS do not reimburse educational psychologist consultations. We are at present awaiting the outcome of a Court ruling on this subject.
Kind regards
The GEMS online team