Active since May 2016
52
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52 reviews1 month ago
GEMS Is Making Me Fight for Every Prescription While My Health Deteriorates
I am extremely frustrated and disappointed by the way GEMS has handled my medical aid matters over the past few months. For almost three months, I have been struggling to get approval for medication prescribed by my treating doctors, despite medical motivations being submitted and my medical history already being available on the GEMS system. My psychiatrist previously prescribed medication that was even approved during my in-patient psychiatric treatment, yet after discharge I was suddenly forced into a long and emotionally exhausting battle just to continue treatment. I have sent countless emails, prescriptions, medical reports, and follow-ups, only to continuously receive delays, generic responses, and excuses. What made the situation even worse is that I recently received a call informing me that my medication had finally been approved. To my shock and embarrassment, when I arrived at the pharmacy, the medication still reflected as declined on the system. This was humiliating, stressful, and completely unacceptable. I have now also submitted another prescription from my orthopaedic surgeon, Dr Tau, and that prescription has also been declined. At this point, I honestly feel like I have to fight GEMS every single time a doctor prescribes medication for me. Is this what members are expected to go through just to access treatment? Instead of focusing on recovery and healing, I spend my time sending emails, begging for approvals, following up endlessly, and worrying whether I will receive medication that my doctors have already motivated for. This ongoing situation has affected me emotionally, mentally, physically, and financially. The lack of urgency and poor communication from GEMS is deeply concerning, especially considering that these are serious health matters affecting people’s lives and wellbeing. I am not asking for special treatment. I am simply asking for access to medically necessary treatment without having to go through months of stress, delays, contradictions, and emotional trauma every single time. GEMS needs to improve its service delivery, communication, and approval processes urgently because this experience has been absolutely exhausting and unacceptable.
2 replies
1 month ago
Still Fighting for Medication & Now Limited Physio After Major Surgeries – GEMS Continues to Fail Me
**Still Fighting for Medication & Now Limited Physio After Major Surgeries – GEMS Continues to Fail Me** I am emotionally and physically exhausted from constantly fighting with GEMS just to receive medically necessary treatment. For almost three months now, I have been battling to get approval for my chronic medication despite detailed medical motivation from my doctor, my full medical history being available, and the medication already having been proven effective during my psychiatric admission. That issue still remains unresolved, and the stress of constantly fighting for treatment has taken a serious toll on my mental health. Now I am facing another battle. After suffering a gunshot wound, I underwent multiple major surgeries on my leg, including an ankle fusion procedure. I am still recovering and learning to walk properly again. Physiotherapy is a critical part of my rehabilitation and recovery process. To my shock, I was informed by my physiothe****** that I only have two physiotherapy sessions remaining. Two sessions are nowhere near enough considering the seriousness of my injuries and surgeries. It honestly feels like GEMS is more focused on limiting costs than helping members recover. Instead of support, members are met with delays, limitations, generic responses, and endless stress while dealing with serious medical conditions. How is someone expected to recover physically and mentally while constantly fighting their medical aid for treatment that healthcare professionals have already confirmed is necessary? I am tired of having to beg for care and rehabilitation. Medication and physiotherapy are not luxuries in my case — they are essential for my recovery, stability, mobility, and quality of life. I urgently need GEMS to stop delaying and limiting necessary treatment and start putting members’ health first.
1 reply
1 month ago
I am extremely frustrated with GEMS
I am extremely frustrated with GEMS. I submitted my ex gratia application two weeks ago, completed all the required forms, and provided everything that was requested. To date, I have received no feedback, no acknowledgement, and no update on the status of my application. What makes this even worse is that this issue has been ongoing for over two months. During this time, GEMS has been refusing to pay for my chronic medication despite multiple disputes, detailed medical motivation from my doctor, and my full medical history being available on their system. There is no communication, no urgency, and no sense that my case is being taken seriously. This lack of response is unacceptable, especially when dealing with health-related matters. Members should not have to struggle like this just to get assistance. I expect urgent feedback on my ex gratia application and a proper resolution to my medication issue.
3 replies
2 months ago
GEMS Approved My Treatment in Hospital – Now They Refuse to Pay and Don’t Care About My Health
I am extremely frustrated and disappointed with GEMS. I was admitted to a psychiatric facility where, after proper diagnosis and evaluation, I was prescribed medication that finally worked for my condition. GEMS approved and paid for this medication while I was an in-patient, which clearly shows that it was recognised as necessary and effective. However, immediately after my discharge, GEMS has now rejected the very same medication for continuation of treatment. This makes absolutely no sense. My treating doctor, Dr Matshoene, has already confirmed that: * There is no suitable generic alternative for my condition * This medication is the one that works for me * The prescription is based on a thorough and correct diagnosis made during my hospital stay Because of this rejection: * I have been left without medication * The progress I made in hospital is being reversed * I am at risk of relapse and already feeling the effects How can a medical aid approve a treatment in hospital, see that it works, and then refuse to cover it when a patient is discharged and needs to continue the same treatment? This lack of continuity of care is not only unfair, it is harmful. To make matters worse, GEMS continues to respond with generic template messages that do not address my case, which shows a lack of proper review and concern. I am now struggling with anxiety, depression, and frustration because of this situation. GEMS has all my medical records and knows the seriousness of my condition, yet they are still denying me the treatment I need. GEMS needs to: * Ensure continuity of care for patients after discharge * Respect doctors’ medical decisions and motivations * Stop denying treatment that has already been proven to work * Provide proper, case-specific responses instead of generic replies At this point, I feel completely unsupported by the very medical aid that is supposed to help me recover. I urgently need this medication approved before my condition worsens further.
2 replies
2 months ago
Terrible Service from GEMS – No Care for Members’ Health
I am extremely disappointed and frustrated with the way GEMS treats its members. Every single time I need to get my prescribed medication, it turns into a stressful and exhausting battle. I have a documented medical history on their system, including being admitted to a psychiatric hospital and being diagnosed with PTSD. My treating doctor, Dr Matshoene, knows my condition and prescribes medication that is appropriate for my health. Yet GEMS continues to delay or refuse approval for this medication without valid reason. This is not just an inconvenience — it is putting my health at serious risk. The constant back-and-forth, lack of feedback, and unnecessary obstacles are taking a huge toll on my mental well-being. It is unacceptable that a medical aid scheme can ignore a patient’s medical history and a doctor’s professional recommendations. Members are paying for a service, but when it matters most, there is no support. GEMS needs to: Start prioritizing patients’ health over administrative delays Respect doctors’ medical decisions Improve communication and provide clear, timely feedback Right now, it feels like they simply do not care about their members. I would not recommend this medical aid based on my experience.
5 replies
4 months ago
URGENT COMPLAINT: No Response on Ex Gratia Application Despite Full Compliance
Dear GEMS Complaints Team, I am writing to formally complain about GEMS’ continued failure to respond to my Ex Gratia application, despite the fact that I have comp**** with all requirements and submitted everything that was requested from me. I have followed every instruction given by GEMS, submitted the necessary documents, and made repeated follow-ups requesting feedback. To date, I have received no response, no update, and no acknowledgment. This lack of communication is unacceptable. What makes this situation even more distressing is that I am living with severe, ongoing pain as a result of my medical condition and surgeries, which GEMS is fully aware of and has on record. The Ex Gratia application is not a luxury—it is a necessity for my medical care and quality of life. The silence from GEMS has left me without support while I continue to suffer daily. As a member, I feel completely disregarded. GEMS’ failure to communicate or provide feedback shows a lack of care and urgency toward one of its members who is clearly in need. I should not have to beg for feedback after doing everything correctly and in good faith. I am requesting: Immediate feedback on the status of my Ex Gratia application A clear explanation for the prolonged delay and lack of response Urgent intervention, considering the severity of my pain and medical condition If this matter is not addressed urgently, I will have no choice but to escalate it further, as this ongoing silence is causing both physical and emotional distress. I expect a response as a matter of urgency. Yours sincerely, Refilwe Mvubu
3 replies
4 months ago
I'm dissatisfied and want to cancel
I'm so disappointed in absa I took an car insurance yesterday and I have been trying to contact them without success they either pickup and mute or hangup after many minutes of holding i am now at a position where I want to cancel the insurance immediately and continue with my current insurance as I don't have time or energy for this ,what will happen when I need them in future if this is what they are doing now call me ASAP 0678369629
2 replies
5 months ago
GEMS Medical Aid failed me
GEMS Medical Aid failed me. Before downgrading, I consulted GEMS to review my medical conditions and chronic medication and advise on a suitable option. I followed their advice. After downgrading, GEMS discontinued my chronic medication, claiming it is not covered. This is unacceptable. Why advise a downgrade that removes medication GEMS already knew I depend on? I submitted a motivation and my doctor submitted a motivation, yet the medication is still not approved. Despite my condition being fully recorded, I am being forced to complete repeated forms while I am not mobile due to multiple leg surgeries from a serious injury known to GEMS. This points to a broken internal system. Even though I am registered for PMB, GEMS continues to reject PMB claims and demands information already on their system. Members should not have to fight this hard for medication and claims. I demand urgent reinstatement of my chronic medication and immediate resolution of my PMB claims.
3 replies
5 months ago
I am disappointed ab...
I am disappointed about how TUT has handled the matter with my daughter after she was hospitalized and couldn't attend classes they expect her to pay for the fees for the same causes as when she came back they couldn't not make her catch up which is so disappointing I was expecting better from them since they are the ones who refered her to hospital she has submitted all documentation but they still want her to repeat the same causes and pay again which is not right im am a disappointed mother my number is 0678369629
0 replies
5 months ago
Gems is stressing me...
Gems is stressing me out I have been trying to get gems to pay claims for a procedure done on hospital ,but they are failing to pay for the medication although the procedure was approve and was cause by a condition that is registered as PMB they keep on sending me the same response even after I have explained this ,gems have all the necessary infomation on their system regarding this incident but they are just lazy to lookup and get answers they don't even pay for the wound clinic for wounds cause by the surgery in question this is really annoying and uncalled for.
2 replies
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5 Star
2 (3.8461538461538463%)
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0 (0%)
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2 Star
1 (1.9230769230769231%)
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49 (94.23076923076923%)