Bonitas Is Useless! Not paying approved chronic claim!

On Thursday 29 August 2024, my Mother (Member) was admitted to hospital with a suspected stroke. She was discharged on Tuesday 3 September, and we were told by the Specialist Physician that she had written out two prescriptions – one for 7 days meds and the other as her new chronic script. I collected the meds for 7 days and immediately emailed the new prescription to your Chronic Department (at 13:54).

When we heard nothing from your Chronic Department by Monday morning 9 September, I called in and spoke with a lady who confirmed that she is capturing the meds on your system. I explained that time is of the essence and that 4 working days had been wasted last week with no-one attending to this. My Mother’s meds were to finish by Tuesday morning 10 Sept. I requested her to mark this as “urgent” and to ensure this was approved on Monday. I called again at around 15:30 the same day to ascertain progress. I was advised that apparently the Rosuvastatin had been declined. I requested her to arrange with the Dr’s office to obtain the required reports, as your company had delayed processing this new script.

I called on early on Tuesday morning, 10 Sept to enquire whether everything had been finalised. I was advised that the Chronic notification letter would be sent to my Mother shortly. On opening the document, I did not see any mention of anything being declined. A second letter arrived shortly thereafter, and now the Statin was showing as DECLINED! I immediately called the Chronic department and enquired as to why this had still not been resolved with the Dr? I was advised that they had spoken with the Dr the previous day and were awaiting the report. I called the Dr’s secretary who confirmed that neither herself, nor the Dr had been called by Bonitas! She immediately sent me the report and I forwarded it to the Chronic Dept. I was then advised that a 3rd letter had been sent. In the late afternoon, I called again to find out why this had still not been resolved, and that we had not received the 3rd letter. Eventually, we received the 3rd and 4th letter simultaneously. The 4th letter confirmed that everything had been approved. Why so many letters, all with differing information?

I went to Clicks Pharmacy after receiving the Chronic confirmation letter. The chronic claim was declined and the Pharmacy Assistant called Bonitas. He was informed that the system won’t allow the new claim as there had been a claim for 7 days worth of meds on 3 Sept!!! The fact is, that the meds were now finished and we needed to obtain a supply for the month. The Assistant was advised to claim again the next morning, which was this morning. I drove back to Clicks and the claim was again rejected! The same excuse has been given. Bonitas now wants us to reverse the hospital pharmacy claim, pay cash for it, and then their system should allow her new script claim!!!

I want to know from Bonitas, how it’s possible to operate a system which isn’t intelligent enough to know that a claim for 7 days has expired and now a new claim MUST be processed? Why can no-one override your system?

My Mother has not had any chronic meds today and I want to place on record that your company will be held liable should we decide to institute a civil action, in a case of my Mother suffering any medical event out of your negligent conduct/incompetence to process her claim timeously.

Furthermore, I shall report your company to the Medical Ombudsman.