Bonitas Lack of Client Centricity and Client Care

I would just like to share my experience with Bonitas Medical Fund for anyone that is wondering what there service is like once you sign up.

In 2023 I was diagnosed with a Bilateral Hernia. The treatment required is surgery and is classified a PMB condition which is required to be covered by Medical Aids. I did all the steps required of us as customers prior to going into Surgery and obtained the pre-authorization from Bonitas but as many of you know and even the medical aids advise is that you should call in prior to going to Surgery to understand your options and co-payments etc. I actually had 2 lengthy conversations with ladies from Bonitas prior to going into my surgery and was advised the following: 1st due to it being a bilateral hernia the recommended treatment is a laparoscopic surgery as opposed to open surgery as it is better overall for physical recovery as well as scaring and cost is the same due to it the bilateral hernia not being a singular surgery but actually 2 individual surgeries if you do open. 2nd I was advised that on the total surgery despite it being a PMB surgery, the medical aid does not cover the mesh which is used in the surgery to essentially close the Hernia at a cost of R5500 and I clearly clarified on 2 seperate calls that this is the total cost of the surgery to me and everything else is covered by Bonitas.

Based on this advice and my affordability I than appealed the decision not to cover the mesh as it seems absurd being a crucial part of the surgery and a PMB condition but I proceeded with the open surgery knowing that at worst I could afford the R5500.

Post coming out of the surgery the following has happened. 1st I was advised by Bonitas that I was actually approved for a laparoscopic procedure (despite prior advice leading to my surgery saying I have to go for the open surgery) which despite being physically and aesthetically better for me, this surgery is also only 1 Hour long as opposed to 3 hours long for the surgery I had to go for. 2nd I was wrongly advised by Bonitas on the cost and subsequently received bills totaling over R20k. I was told by Bonitas its because thats what some policy/schedule says they should pay out and that I would need to appeal.

Please keep in mind that the due to their advice I now also have had 3 hours worth of theater time and Doctor and Anesthetist bills. So not only are they saying they won't cover it post the surgery but also I know have 3 times the size bill because of their advice as it was a 3 hour procedure not 1.

I have than spent the next 6 months facing what is the worst customer experience interaction in what must be history. I believe I have called maybe 50 times and followed every internal process imaginable within Bonitas and all I have asked each time is for the call to be listened to and based on the advice given the claims be corrected. I will not go into the detail of each call but I have very clearly and calmly followed everything requested of me by Bonitas but I will instead provide the outcomes. Each time Bonitas has closed the case without providing a single bit of feedback to me and I have had to call again each time with a 10 day delay because thats the best turnaround time they have. Each time my query has not been answered in fact they have not even listened to the voice recording even though I have shared the exact time/dates and even the number I phoned off of. Each time my complaints haven't even been logged onto the system correctly as it has been squashed under the weight of bureaucracy hoping I would go away.

You would think the management level would be better but I have escalated it twice in recent months to the Team Leaders by the name of Mohammed Moola and Neyo. Each promising that they have heard my concerns and gone as far as to reassure me that they as managers would at least follow proper process. Mohammed confirmed that there were multiple errors in the handling of my case and even one of my queries was closed with a different patients files and that he will take it up internally with employees and disciplinaries would need to be followed. Again I was promised resolution and he would personally call me back. 3 weeks followed were he ducked, dodged and dived to avoid me and eventually Neyo was involved as a separate team leader to assist and she once again started the whole process again and promised feedback in 10 days. Today I called back as it was Day 15 again from the latest promise with no feedback and this is what I was told.

There is nothing on my file about needing to listen to the voicecall and this case has been closed as declined, after 6 months of countless hours and effort from my side they did not even have the respect to me as a person to the due diligence to actually hear me out with regards to my query. I truly have no idea what to do or how to even approach it as it has been genuinely 50 calls and they haven't so much as raised the correct query or given me feedback even once. I am simply sharing this experience but I am currently going through a cancer related query and I can promise you the service is consistent in my second interaction.

I just wanted to share my experience with you for when you make your decision around whether this medical aid will truly have you as the client in mind when you make your decisions. I have had this experience with 2 very serious conditions that are both supposed to be covered under PMB and if its happened to me in such a manner I doubt very much I am unique.