Bonitas Failing to Honour PMB Claim – Referral Ignored, Law Breached

I’m extremely disappointed in how Bonitas is handling my Prescribed Minimum Benefit (PMB) claim under the BonStart plan.

I had a valid referral from my in-network GP for concerning heart symptoms (palpitations, ECG abnormalities, elevated resting heart rate). There were no cardiologists in the BonStart network, so I was forced to see an out-of-network specialist. Bonitas then rejected most of my claim (Claim No. ***5), paying back only R514 out of R6,000.

This is despite:

A valid referral from a BonStart-network doctor

The diagnosis (I49.8 – cardiac arrhythmias) being a listed PMB

No DSP specialist being available (making this an involuntary consultation)

Bonitas’s own written response even admitted the procedures would be covered if classified as PMB, yet they refused to do so — despite the diagnosis and legal criteria being met.

I have submitted the claim, referral letter, ECG results, and a formal escalation to Bonitas and the Council for Medical Schemes (CMS). If this is not resolved urgently and in line with the Medical Schemes Act, I will pursue full reimbur*****t through regulatory and legal channels.

Bonitas needs to be held accountable — this is not just unfair, it’s ********. Other members: check your PMB claims carefully. You may be losing out on thousands you're legally entitled to.