BONITAS HAS LEFT US FACING AN URGENT OPERATION WITHOUT AUTHORISATION – HOURS BEFORE SURGERY

# **BONITAS HAS LEFT US FACING AN URGENT OPERATION WITHOUT AUTHORISATION – HOURS BEFORE SURGERY**

I am writing this complaint out of extreme frustration, disappointment and concern regarding the shocking manner in which Bonitas has handled the hospital authorisation for my husband's urgent back surgery.

We are Bonita's members, and we have always expected that, when a serious medical situation arises, our medical aid would provide the necessary support and assistance. Instead, at a time when my husband urgently requires surgery, we have been left with uncer*****y, unanswered questions and absolutely no clarity regarding whether his scheduled operation will be authorised.

## **URGENT SURGERY RECOMMENDED BY A SPECIALIST**

On Wednesday, 9 September 2026, my husband was examined and diagnosed by a specialist with serious and severe back problems.

Following his assessment, the specialist advised that my husband requires surgery as soon as possible. This was not an elective procedure that could simply be postponed for convenience. The recommendation for surgery was made by a medical specialist because of the seriousness of my husband's condition.

The necessary arrangements were subsequently made, and the operation was scheduled for Tuesday, 15 September 2026, at 08:00.

The theatre was booked.

The hospital made the necessary arrangements.

Medical professionals prepared for the procedure.

Yet, despite all of this, the most important authorisation required from Bonitas – the hospital authorisation for the actual surgery – remained outstanding.

## **BONITAS HAS PAID FOR AND APPROVED OTHER TREATMENT RELATED TO THE SAME CONDITION**

What makes this situation even more difficult to understand is that Bonitas has already paid for and/or approved several consultations, investigations, treatments and benefits relating directly to my husband's back condition.

These included, among others:

* Physiotherapy; * X-rays of his back; * An MRI scan; * Pain medication; and * A back brace that my husband has been instructed to wear after the procedure.

Bonitas therefore clearly had access to information relating to my husband's medical condition and the investigations and treatment associated with it.

The medical journey leading up to the specialist's recommendation for surgery was therefore clearly documented through the various consultations, diagnostic procedures and treatments that had already taken place.

This is what makes the current situation so difficult to understand and accept.

How is it possible that Bonitas can approve and pay for physiotherapy, X-rays, an MRI scan, pain medication and a back brace relating to the same serious back condition, but leave the member without clarity regarding the hospital authorisation for the actual surgery recommended by a specialist?

Bonitas has effectively recognised and paid for the various stages of diagnosing and managing the condition, yet when the matter reached the point where a specialist recommended urgent surgery, we were left waiting for the most critical authorisation of all.

## **THE CASE WAS REFERRED TO MEDICAL ADVISORS – BUT WE WERE LEFT WAITING**

The hospital advised us that the case had been referred to Bonitas' medical advisors during the previous week and on 14 September 2026.

We were informed that the normal turnaround time was between 48 and 72 hours.

Despite this, there was still no decision, no authorisation and no meaningful feedback as the date and time of the surgery rapidly approached.

The hospital made several attempts to contact and follow up with Bonitas.

We were repeatedly informed that there was still no feedback regarding the procedure.

The uncer*****y continued while the operation was already scheduled and the theatre had been booked.

## **MONDAY AFTERNOON – BONITAS SIMPLY COULD NOT HELP US ANY FURTHER**

On Monday, 14 September 2026, at approximately 16:00, we were informed that Bonitas would not be able to provide any further assistance that day.

This was less than 24 hours before my husband's scheduled operation.

His surgery was scheduled to take place at 08:00 the following morning.

The theatre was already booked.

The hospital had been trying repeatedly to obtain feedback.

And yet, at approximately 16:00 on the afternoon before the operation, we were effectively left without the answers and authorisation that we desperately needed.

What exactly were we expected to do?

Were we expected to arrive at the hospital the following morning without knowing whether the procedure had been authorised?

Were we expected to cancel an operation recommended as urgent by a specialist?

Were we expected to postpone a scheduled procedure because Bonitas could not finalise its internal processes in time?

Or were we expected to proceed with the surgery while facing potentially significant medical expenses because our medical aid had failed to provide clarity?

This is completely unacceptable.

## **THE ADDITIONAL FINANCIAL UNCER*****Y MAKES THE SITUATION EVEN WORSE**

In addition to the outstanding hospital authorisation, we were informed of a possible shortfall relating to the spinal prosthesis required for the procedure.

The hospital provided us with the following information:

* **Internal Prosthesis Limit:** R38,420.00 * **Prosthesis Quotation:** R54,700.00 * **Possible Shortfall:** R16,280.00

We were also informed that it still had to be confirmed whether the spinal prosthesis would be covered under the relevant benefit.

Once again, we were left without cer*****y.

So, not only were we waiting for confirmation regarding whether the hospital procedure itself would be authorised, but we were also left without clarity regarding the extent to which an essential spinal prosthesis would be covered.

This placed us in an impossible position only hours before a serious and urgent operation.

## **THE LACK OF COMMUNICATION HAS BEEN EXTREMELY DISTRESSING**

I understand that medical aid schemes have processes, policies and clinical protocols that need to be followed.

However, there must surely be a point where common sense, urgency and basic consideration for a member's circumstances come into play.

This is not a minor administrative issue.

This involves a patient who has been diagnosed with severe back problems.

A specialist has recommended urgent surgery.

The surgery was scheduled.

The theatre was booked.

The hospital repeatedly attempted to obtain the necessary feedback.

And still, hours before the scheduled procedure, we were left without an answer.

The stress and emotional strain caused by this situation have been enormous.

A patient facing serious surgery should be allowed to focus on their health and recovery.

Instead, my husband and our family have been forced to spend the hours leading up to his operation worrying about whether Bonitas will authorise the procedure and whether we may suddenly be confronted with substantial medical costs.

That is simply not the level of service or support one expects from a medical aid scheme when dealing with a serious medical situation.

## **WE PAY FOR MEDICAL COVER FOR TIMES LIKE THIS**

Medical aid is not something one should only be able to rely on when everything is simple and straightforward.

Members pay their contributions month after month with the expectation that, when serious medical treatment is required, the scheme will process legitimate requests efficiently and communicate clearly.

Bonitas has already paid for and approved several aspects of the diagnosis and treatment of my husband's condition, including physiotherapy, X-rays, an MRI scan, pain medication and a back brace.

Yet, when a specialist recommended that surgery should take place as soon as possible, we were left fighting for answers regarding the most important authorisation of all.

When a specialist recommends urgent surgery and the procedure has been scheduled, it is unacceptable for a member to be left without clarity until the very last minute.

The complete lack of urgency and the poor communication in this matter have been deeply disappointing.

## **BONITAS MUST URGENTLY PROVIDE ANSWERS**

We now require immediate intervention and clear answers from Bonitas regarding the following:

1. **Will my husband's hospital procedure be authorised?** 2. **Why has the authorisation taken so long, despite the matter having been referred to medical advisors last week?** 3. **Why was no final decision communicated before the afternoon prior to the scheduled surgery?** 4. **What steps were taken by Bonitas to process and prioritise this urgent case?** 5. **Will the spinal prosthesis be covered under the applicable benefit?** 6. **What amount, if any, will we personally be required to pay?** 7. **Why were we left facing an urgent operation without the necessary clarity and authorisation?**

We do not want generic responses, excuses or another message telling us that the matter is still being investigated.

We need immediate and meaningful action.

## **THIS MATTER REQUIRES URGENT INTERVENTION**

At the time of writing this complaint, my husband's surgery is scheduled for **Tuesday, 15 September 2026, at 08:00**.

The fact that we have reached this point without cer*****y regarding the required hospital authorisation is unacceptable and has caused unnecessary stress and anxiety during an already extremely difficult situation.

Bonitas must urgently intervene, finalise the outstanding authorisation and provide us with clear written confirmation regarding the procedure and the applicable benefits.

No medical aid member should be left in this position only hours before an urgent operation.

We expect Bonitas to treat this matter with the seriousness and urgency it deserves and to provide immediate feedback and a proper resolution.

**Bonitas has paid for the consultations, investigations and treatment relating to my husband's back condition. Yet, when he reached the point where a specialist recommended urgent surgery, we were left without the one authorisation that matters most – the authorisation for the surgery itself.**

**We pay for medical cover for times like this. When we need it most, we should not be left fighting for answers hours before an urgent operation.**