Gems
CLAIMS STILL NOT PAID TO MEMBER AFTER 5 MONTHS

I am tired of the degree of incompetence of GEMS medical aid. My wife and I had both been in for surgery in August and September 2013, respectively. I received pre-authorization from GEMS beforehand.

- I then emailed the claims 5 times each (GEMS did not receive them)
- I faxed the claims through once (GEMS did not receive them)
- I went to the walk-in center in Cape Town TWICE to personally take the claims in (GEMS did not receive them)

Suddenly in December 2013, the one claim is received. However, they paid the claim to the supplier which I already paid for personally (I INFORMED THEM BEFORHAND THAT THE CLAIM SHOULD BE PAID TO ME PERSONALLY). When I enquired about this, their response was that I had not submitted a proof of payment with the claim. (This even though I still have the original documents filed that I took into the walk-in center and proof of the emails I send, ALL HAVING THE PROOF OF PAYMENT ATTACHED)

After several calls to GEMS, all acknowledging the receipt of my claims, the claims have still not been paid. Now all of a sudden GEMS won't answer any calls I make to them.

Company: Gems
Country: South Africa
City: PRIMECURE DENTAL DEPARTMENT

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