Government Employees Medical Scheme [GEMS]claims

L Nov 28, 2017

I have the following queries and require detailed explanation for each point below. I will be seeking legal advice on below points if this problem is not solved as a matter of priority:
- I received a letter this year in June 2017 stating: Contribution Reconciliation. Please explain detailed billing regarding this as the amount that I have over paid is stated as the amount that is in arrears.
- I have a medicine access card that states clearly that my chronic medication is approved and is due on the 30th of every month. This medication has not changed since this card has been given to me.
- My statement in January 2017 was R2178 and in February it was R2631, I presume this was an increase in the medical aid. I was never notified about any increase, if I would have been notified about this arrangement would have been made regarding the debit order that is taken off every month.
- I received a letter in September 2017 stating my account is in arrears of R5405, please explain how you got to this amount,
- According to my detailed statement my medical aid is as follows:
- Acute medication: R5642
- Chronic medication: R17 146
- Day to day limit: R1529.09
- Why do I receive a letter every month about my account being in arrears when a debit order goes off automatically
- I was NEVER notified about any increase regarding my medical aid going up
- I went for an MRI on the 15th of November 2016, which my medical aid has authorised, the authorisation number is [protected], and now you are refusing to pay this. This has been going on for longer than a year.
- My chronic medication is supposed to be paid by you as per my card approved by you. I have been paying this out of my own pocket since the beginning of this year (January 2017), yet I have statements where you guys have approved my chronic medication which I have paid out of my own pocket.
- Why is it approved some months and other months not?
- My account has been suspended since the beginning of this year, but yet you still taking money every month and I am paying everything out of my own pocket.
Thank you for your assistance regarding this matter. I have all documentation for points stated above, please advice if you will be needing this and I will gladly forward all documents required.

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