LP
Lauren P

1 reviews | Active since Feb 2024

09 Apr 2024, 12:42

Bad service

I have received the worst service calling in as my claims are being rejected in which I have received authorization which was done in hospital on the 26th of March and discharged on the 28th of March at rosebank netcare clinic. My procedure was initially supposed to be the 22nd of March at mediclinic Morningside which was canceled and only the CT scan was done. I called then the authorization department on the 25th of March to provide updated codes and procedures which was approved for the surgery on the 26th of March 2024. I have been calling in since the 8th of April as they keep on rejecting the drs claims. Authorization number ***8 was given and all codes and procedures were approved now no claims wants to be paid to the drs.

I was first told by Ashton that the claim was submitted incorrectly as in room service and not in hospital. I called the drs rooms, they did submit the claim correctly as in hospital. The case manager has updated my hospital file and sent it twice, the 2nd of April and today the 9th of April. I called again twice today, I spoke to svuyo which she picked up the updated file which I was now told it's been sent to the case manager's. Why am I as a paying customer receiving such poor service and incorrect information. I was told by Ashton a referral letter from my gp in the claims department is needed which was in correct. I also spoke to Stuart and Thabo who helped me they told me the authorization number suppose to be linked to the claims which was not done and they have done so and still my drs claims and bills are being rejected.

I never would have gone for the procedure if I never received authorization from the authorization department.

Call ref numbers B0N***5, B090424Q4J4XD ref,Bon050424Q4BGPW ref,B0N***6

I need these claims to be processed and paid. Someone is not reading notes Query number 080424Q4H4D2 and 080424Q4H3Y9.

Thabo has made notes and sent the claims for reprocessing now they still rejecting and refusing the claims, in which the authorization was already given and approved for my surgery at netcare rosebank clinic.

Can someone higher please assist in this matter as this is now being ridiculous and I'm being given the run around

0
Replies (5)
Bonitas Medical Fund
Bonitas Medical Fund's reply09 Apr 2024, 12:56
Official
Hello Lauren P

Thank you for notifying us of your complaint. We are so sorry to hear about this, we are glad that you brought this to our attention to resolve. 
 
We will investigate this matter. 
 
We appreciate your patience while we are resolving this query for you. 
 
Kind Regards 
 
Bonitas Team 
LP
Lauren P's update12 Apr 2024, 14:02
Reviewer Update
Is anyone going to help me? I called in again today call ref no 120424Q4P4W8 now I received an email again saying no authorization was given and I was given authorization for the codes and I still have the proof 080424Q4FW7N - claim query - *** [MI***]. I am no fed up and going to the ombudsman
LP
Lauren P's update12 Apr 2024, 15:30
Reviewer Update
Is anyone going to assist by doing their job correctly or ignore me and do I need to get an attorney involved and sue Bonitas? My recovery has just been pure stress
LP
Lauren P's update12 Apr 2024, 19:08
Reviewer Update
Good evening.
Please can someone check this claim as well ref number 050424Q4BGPW this claim is also urgent that needs to be processed

LP
Lauren P's update14 Apr 2024, 08:17
Reviewer Update
Can someone please see ref number 080424Q4H3Y9 they are still doing something wrong with the surgeons claim, first they say the amount of r28,632.15 is being reprocessed and only paying R20,607.39, there are procedure codes in there, the entire email is typed out wrong and does not make sense. There are procedure codes there, are you not paying the procedure codes?????? How can you reduce the claim amount and to who did you speak too?????