A Deafening Silence

A submission was made by us to the Council for Medical Schemes [CMS] on 12.12.22 regarding treatment that should have been a PMB Case [malignancy], but which Bonitas treated as an ordinary ‘acute’ case, the considerable cost of which was paid by us because our ‘Day-to-Day’ account had already been used up. Each time a subsequent request was made to Bonitas to reconsider it as being a PMB case, their same staff member rep**** that there was no claim as our Day-to-Day account had been exhausted. Earlier this year, after apparently being reviewed by the CMS, authority was received from Bonitas for PMB oncological treatment/medication during 2023; but although it is now 15 weeks since referring the case to the CMS only the 2022 costs of the Skin Specialist and of the Pathologist have been refunded, with the cost of the medication prescribed for treatment of the carcinoma during 2022 not having yet been refunded. Several emails to both the CMS and to Bonitas requesting updates on progress with this Case, and specifically when the amounts we paid for the medication will be refunded, have gone unanswered. A ‘deafening silence.’ Resubmission of the relevant accounts for payment as a PMB item has only resulted in the Bonitas ‘PMB Team’ forwarding a duplicate ‘Care Plan’ for 2023. Bonitas states on its website [ https://bestmedicalaid.co.za/why-join-bonitas-medical-aid.html ] that it is “a highly trusted medical aid scheme, providing you with stability, support and professionalism over many years” and while for the most part we agree, in this specific case this has not been our experience. When we try to use Bonitas’ Whatsapp, it puts us in a loop requesting us to ‘be patient’ without anyone ever helping us. The last time we tried using their Whatsapp [11 November 2022] it kept us waiting from 10:33 to 11:34, at which stage we finally gave up. Their Android App does the same – our experience is that we are ‘queued’ but we never reach the front of the queue. The CMS [whose stated aim is “to serve the beneficiaries of medical schemes and the public by investigating and resolving complaints in an effective and efficient manner. By doing this, we ensure that beneficiaries are treated fairly by their medical schemes”] does the same – our subsequent emails to them have just been ignored. - D B Reid & F X Herbst [main member]