GEMS
Error in processing and failure to answer Queries

I have had many problems with claims processes this year. Like never before.
o Firstly, many claims per fax were not processed, and I had to fax and email them again. Up to 3 times.
o Queries per fax and email was not met, in fact I was told they were not received!
o Claims were wrongly processed.
Supplier was paid instead of the Member
Amounts for procedures denied because of "duplicate claim", when it clearly is not a duplicate procedure
o When I called the GEMS's customer line the person could not help me, and the Claims department for Dental could not help me.
The person at the Claims department for Dental could also not help me and asked me to fax the Doctor's Invoices again!!
I cannot understand how my claims can be processed, but the Claims Dept do not have the relevant Documents and Invoices on the system or in a file?
Why is it necessary to submit claims numerous times to get response, and when processed, it is wrong.
Why can I not get solutions when I call Gems, as well as email Gems?

Company: GEMS
Country: South Africa
City: Cape Town

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