Bonitas fail to honor its benefits being PET Scans that is in their plans

I am writing to raise a concern regarding the rejection of a PET scan request for a member of the plan, who is currently registered on the Bonitas oncology benefit. I am a Bonitas member on the Primary plan, and the member is an approved oncology patient under this plan. Based on my understanding, the Primary plan includes cover for PET scans as part of oncology treatment where clinically required.

However, the request for her PET scan was declined by Bonitas, with the reason provided that it does not comply with clinical and funding protocols, and that the PET scan benefit is not included in the Bonitas Primary plan. This is both confusing and concerning, as it appears to contradict the stated oncology benefits associated with the plan. A PET scan is often a critical diagnostic tool in cancer management, and the denial of such could have serious implications for her treatment and care. On the 2026 plans, pet scans are included. Seems like another situations where the medical aid is failing to honor its plans and yet paying members have to suffer at the hands of administrators. I kindly request the following:

•A clear explanation of why the PET scan was declined, specifically referencing the clinical and funding protocols used. •Confirmation of whether PET scans are covered under the Bonitas Primary plan oncology benefit, and under what conditions, as this is now misleading especially for cancer related benefits •Guidance on what steps or additional information may be required to have this decision reconsidered.

I would appreciate an urgent review of this matter, given the importance of timely and appropriate cancer treatment.