Medscheme/Gems Chronic care

[TELESPHORE]

Who of you have problems with the way Medscheme administrates Chronic care (PMB) for GEMS. I am seriously considering a complaint with the Council of Medical Schemes and the Competition tribunal.

 

[armitage]

My parents have had a lot of issues on GEMS. They are both on heart medication and GEMS insists almost every time when they have to refill their prescriptions that they get a generic. I have no issue with generics most of the time, but when my father can't even get up from bed for days on end after he's taken a generic, it seems there is something wrong with their administration.
It's the age old problem, an bureaucrat imposing cost saving measures on a person's healthcare.

Also the schemes use a Medical scheme rate for paying service providers. They keep on telling me to use contracted in providers that will charge their rates. Case in point I will be going to have my wisdom teeth removed in Feb. I know for a fact that the medical aid will only cover about half of my expenses and especially the anesthesiologist will be charging me more than the MSR. Now how the hell am I supposed to "shop" around for a good anesthesiologist? The few that i've been able to get ahold of just blithly inform me that they do not charge MSR but rather "private rates" and if I do not like it then I am free to go to another provider.

Irritates the living crap out of me.

In a few months I will also get ready to get lasik surgery. Seems GEMS just sees it as "cosmetic" so they will not cover the procedure. never mind that I won't have to use my optical benefits for the next twenty years as I will have perfect vision. Ass ended logic there it seems to me.

 

[TELESPHORE]

Thanks Armitage. Yes it seems like when Chronic issues and day to day is concerned GEMS with Medscheme is a problem.
You are 100% correct with "It's the age old problem, an bureaucrat imposing cost saving measures on a person's healthcare", I am formulating a complaint to the Council of Medical Schemes and the Competition Tribunal and would like as much input I can gather.