GEMS
Why cant the scheme help pensioners/patients

I mailed GEMS on behalf of my mother twice to query amounts not paid by the scheme but they failed to feedback for 2 weeks now. I indicated to the scheme that my mother is going for dialysis 3 times per week and will go to specialists regularly and they advised that her GP should fill a certain form which would later be examined by the scheme and authorised should it be necessary. The form was authorised and we were told that the scheme would cater for all costs due to the nature of her condition. I have therefore received claims from a Dr and the hospital indicating her failure to pay and after querying with the scheme on numerous attempts the remainder of the amount was paid by the scheme and the member paid 80% of the amount due to the letters from attorneys being levied against her. The hospital is now charging over R700 and the scheme has failed to respond to the queries yet there is an automated response that my query will be dealt within 48 hrs. What I dont understand is that if you call them, you'll be on hold for at least 30 min until you get to the right person and because the 2nd time I mailed them, they failed to respond having mailed the complaints & enquiries dept

Company: GEMS
Country: South Africa
City: Gauteng

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