BONITAS MEDICAL "AID" OR BONITAS MEDICAL NOT AIDING AT ALL!!??

BONITAS VS DENIS SAGA:

More than three months ago, I visited a Specialist regarding Major issues related to my Sinuses. After getting a 3d Scan, it became clear that I required urgent surgery for a Extraction of a Cyst which was 25 x 40mm in size stretching from my Palate to my Sinus cavity. In the weeks leading up to the procedure, the Cyst ruptured into my sinus, which caused severe discomfort, as a result of Infections, Inflammation and fowl odor/discharge coming from the ruptured bone Cyst. (thus my decision to promptly visit a Specialist)

Bonitas referred the Pre-approval to Denis, who then sent me a Pre-Approval with comments made to it regarding the Pending Surgery.

To date Bonitas/Denis has covered in the region of 16% of the Total cost related to the Surgery, by paying 50% of the Hospital Charge.

The Specialist who performed the Surgery has been paid R11500.00 by me personally, with nothing paid for by the Insurer.

I've have been handed over by some of the Medical Providers, due to overdue accounts, of which I had already paid in excess of R30'000.00 on, without a single refund from Bonitas paid back to me!!!

Even should they refund me according to my Policy Schedule Inclusions, I will be forced to immediately do further Payments on accounts currently handed over.

I've sent them my bank statements, Proof of Payments & each Medical Provider's Statements, which verifies all Payments done by me the Member.

The Cherrie on top is, I may have further financial strain / loss on Gap-cover, due to Denis / Bonitas failing to send me the Detailed Claim Approval Schedules, which the Gap-cover requires upon submission of a claim for shortfalls related to urgent Medical Procedures partially covered by the Medical Insurer.

I've now issued them a notice of intent to refer the matter to the medical ombudsman, should they not provide me with the Claims Statements requested.

IN 2021 I'VE HAD OVER R60'000.00 OF EXPENCES RELATED TO MEDICAL AID / GAP-COVER AND URGENT SURGERY PAYMENTS TO MEDICAL PROFFESIONALS.

MY MEDICAL AID HAS AT CURRENT STAGE HAD AN EXPENCE OF JUST OVER R10'000.00??? (BASED ON STATEMENTS PROVIDED BY MEDICAL PROVIDERS)

IF THIS MATTER CONTINUES DOWN THE CURRENT PATH, I WILL FORFEIT ON A CLAIM TO GAPCOVER & I WILL BE HANDED OVER BY MEDICAL PROVIDERS, IRRESPECTIVE OF HAVING MEDICAL AID.

CAN SOMEONE AT BONITAS PLEASE ELEVATE THE MATTER TO SOMEONE WHO CAN ASSIST ME ACCORDINGLY, AS THE MATTER HAS DRAGGED ON FOR MORE THAN THREE MONTHS FOLLOWING MY URGENT SURGERY, AND MOST LIKELY WILL RENDER ME BANKRUPT AS A RESULT OF MY MEDICAL AID'S NEGLEGANCE AND ********* BUSINESS PRACTICES.

SOS, PLEASE HELP!!!!! I'VE PROVIDED YOU WITH ALL REQUIRED DOCUMENTS AND DETAILS REQUESTED, YOU'VE DONE ABSOLUTELY NOTHING TO "AID" MY HEALTH AND HAVE CAUZED ME FINANCIAL AND EMOTIONAL TORMENT, AS A RESULT OF YOUR NEGLEGANCE.