Bonitas Keeps Declining Valid Claims Despite Sufficient Funds

I have been a member of Bonitas since 2013 and never experienced any issues. However, since the migration to Momentum, my experience has been extremely disappointing.

On 23 May, my son dislocated his shoulder during a rugby match and was rushed to the ER. The doctors had to take X-rays before putting the shoulder back in place, and then another set of X-rays afterwards to confirm everything was fine. Since then, I have been struggling with Bonitas, as they keep declining payment to the service providers. The reason code given each time is “insufficient funds,” yet I know there are more than enough funds available in my savings to cover the doctor, hospital, and X-ray bills.

According to my medical aid plan, these expenses should be paid from my day-to-day savings, which I contribute to every month. Instead, I am now forced to pay these bills out of pocket, despite having sufficient savings available. This has been incredibly frustrating and exhausting. Every week I call Bonitas, and each agent confirms that my savings are sufficient. They escalate the matter to the Claims Department, but the claims are still declined over and over again.

This is unacceptable service, and I am left paying medical bills unnecessarily, even though I have the funds available in my plan.