Bonitas applies blanket approach to reject medical care

My dad suffered a back injury in 2012, he has subsequently been for a number of corrective surgeries. A result of his injuries in 2012 has left him a semi-paraplegic. Non of the corrective surgeries has been successful, As part of the care option offered by Bonitas they have provided back and neck care from a physio the******, which has been unsuccessful in terms of treating pain, and his inability to function.

In early 2019, my parents consulted with a doctor that administer's physical medicine and they requested Bonitas to pay for these sessions from a special fund as Bonitas PMB Department rejected their request. We subsequently appealed the rejection as my dad went for the treatment and paid from his own pocket (which i may add is very limited due to him being a pensioner and his disability), he nevertheless paid for the treatment as it was his last resort for a better quality for life.

We appealed the decision in May 2019 and to date (30 September 2019) have not received a response from Bonitas. Numerous calls and emails have been sent. We appealed the decision and requested assistance from Bonitas Finance Scheme Fund Management for the following reasons:

1. For the first time in 6 years since my , Mr Pillay’s, back injury, he has been able to perform daily tasks without pain or limitation; 2. He has been able to sleep throughout the night and does not suffer from or has minimal spasms; 3. After the last failed surgery and failed treatments from physiotherapy, we thought that he may never be able to have quality of life back. He could not put on for example his own jacket, now after a few treatment from the doctor administering physical medicine, he is able to put on his jacket by himself. 4. Bonitas is in the business of improving or providing healthcare needs, and it is stated in your website that you don’t apply a “one-size fits all” approach, so why were we not given the benefit that the physical treatments offered by Dr S is valuable to Mr PIllay’s health care needs and ultimately contribute to improved living standards? 5. We are more than willing to contribute the costs up until now for I’m our own pocket because we see the value, and it is quite disappointing that Bonitas does not see the value? A blanket approach was app**** by inexperienced staff as they did not even interpret the service codes correctly and advised me that it related to eye procedures! 6. This treatment can help so many people in the same plight and will save Bonitas millions of rands (if that is the aim of rejecting our claim) in expensive and invasive and unhelpful surgeries! 7. The physiotherapy sessions originally approved was futile - you are free to contact the Back Clinic and request for their feedback.