Bonitas - Incorrect CLAIMS (PMB benefit a joke)

My husband has Conoary Artery Heart Disease over and above Hypertention and Hyperlipedamia. Which means he needs to see a Cardiologist at least once a year - Bonitas has listed all his chronic conditions on his Care Plan Treatment Card but refuse to add the Cardiologist to the plan - every 2 years we have the same fight over and over again - All Treatment that he receives from the Cardiologist as well as the blood test is claimed from his Day-to-Day Benefits and depletes his benefits totally within the first month of the year - instead of payments being paid from PMB benefits they process the claim under day-to-day benefits depleting all funds forcing the member to pay cash for medical expenses throughout the year. It has taken me 4 months fighting weekly for claims department to rectify their stuff up - reported them to CMS and still no results ; in the mean time we are forced to pay cash for benefits that are covered on medical aid. CMS states that all chronic medication including Blood pressure tablets and Cholestrol tablets must be paid from PMB without Co-Payments yet every month using Bonitas service provider Pharmacy Direct we have to pay co-payments for both these medication ; even though the tablets are approved on the Care plan. When ever I speak to a consultant - it is the same pathetic response "Sorry a Cardiologist is not on your care plan" When I ask then what doctor should treat my husband for his heart condition - they sit quietly and cannot advise which doctor treats heart condition failure - most probaly a orthapedic! Please employ people with brains because the bunch of consultants that i have dealt with have no clue that a CARDIOLOGIST is a heart specialist and a PULMANOLOGIST is a lung specialist. 4 months of the year has passed and Bonitas still has rectified their stuff up - ALL treatment and test from the CARDIOLOGIST needs to be claimed from PMB and not day-to-day benefits. Please rectify your system to what it was previously where we as members can view where our claims are allocated to because now we are unable to see to which benefits our claims are processed and everything gets allocated to day-to-day benefits depleting our funds before 6 months of the year is over. We pay R4105.00 per month for 1 member plus co-payments on chronic medication and all that you can allocate to the member is R12 000.00 for the year Day-to-DAy benefits. (which you get from us in 3 months premiums - We pay Bonitas R36 945.00 for 9 months of the year plus the R11 466.00 for the 1st 3 months of this year meaning a total of R48 411.00 - almost R50 000.00 - is paid to Bonitas for this year only and all you can allocate to a member is R12 000.00 day to day benefits giving him R1000.00 per month; knowing very clearly that this is insufficent for a person suffering from chronic diseases and over the age of 50. - Bonitas recieves a profit of R36 411.00 from 1 member only!!)

As a medical aid you are fully aware that cost of medical expenses are increasing yet all you do is increase the members fee but benefits do not increase to cover medical expenses. You provide benefits that mean nothing because it doesn't cover the member as all claiims are from day-to-day benefits which is R1000.00 per month - where 1 blood test is over R3000.00 .

Please rectify your stuff up and allocate claims correctly - it is pathetic that we as members have to do your work for you in order to receive our benefits.