The Rules of the Scheme make provision for GEMS members, healthcare providers and third parties who would like to assist a member in lodging a complaint with the Scheme. These parties may lodge a complaint with the Scheme via any of the following channels:
Using these channels to lodge a complaint will ensure that the Scheme responds to a complaint. The Scheme will respond within 48 hours from receipt; however, there are complaints that need clinical input and investigation and these would reasonably take longer to resolve. Rest assured that you will always be informed of the status of your complaint and the Scheme will work tirelessly to make sure that the complaint is resolved quickly and efficiently.
If you are not satisfied with the response, and if all efforts to resolve the issue with the Scheme fail, then the complaint can be escalated to the Scheme's Dispute Committee for a decision.
The Dispute Committee is an independent committee which ensures that disputes between the Scheme and a complainant are settled. The decision by the Dispute Committee is final and binding on the Scheme.
If you are also not satisfied with the decision of the Dispute Committee, then the matter can be referred to the Registrar of the Council for Medical Schemes (CMS) for further resolution.
If a complaint is submitted to the CMS before it has gone through the Scheme's Dispute Committee, then the matter cannot be brought to the Scheme's Dispute Committee. It is therefore important to note that a complaint should first be brought to the attention of the Scheme for a resolution before a complaint is submitted to the CMS.
Remember that having a complaint resolved by the Scheme and CMS is at no cost.
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