BONITAS MISLEADING THE PUBLIC

I have joined Bonitas Medical Aid on 01-09-2016 on their Standard Plan. I was happy with the benefits that they provided and their services was great. I started running into medical problems with my thyroid which resulted in excess weight gain in a short period of time. I contacted my GP and visited an Endocrinologist to investigate and treat the thyroid and weight issue. The Endocrinologist motivated and suggested bariatric surgery.

I contacted Bonitas and was informed that my Standard Plan did not cover said surgery. I upgraded my plan to the most expensive plan (Bonistas Comprehensive) on 01-03-2018. I had a battery of blood tests done, ultrasound of abdomen, gastroscopy, numerous consultations with a psychologist and finally followed a full diet program pre-op supervised by a dietietian.

Upon submittance of my pre-authorization for hospital and the surgery, I was point blank informed that authorization was denied and that I should pay the surgery out of pocket. I was told that the Rules changed since 2018 to disallow bariatric surgery on ANY of their plans. I had no knowledge of this and trying to find details on their website pertaining to Rules are deemed a nightmare as it is listed on Bonitas website containing links to 24 pdf documents with no indication of what they might contain such as “Appendix 1-2018” etc. I have not received any communication from Bonitas that these Rules were changed and that bariatric surgery is excluded (If I had known this, I would not have changed to the Comprehensive Plan and incur all these huge premiums per month!).

On Bonitas’s own website there is a section under the members section called GUIDELINES under HOSPITAL you find a guideline called Bariatric surgery for morbid obesity - Bonitas 15/08/2016 (315797). In this official document from Bonitas on their own website more details on bariatric surgery is given (with pictures) and the last paragraph: “It is important that you contact your scheme prior to surgery to determine if bariatric surgery is covered on your option, and to what extent the cost will be covered. On options which consider funding, the application must be from a bariatric surgery facility accredited by the South African Society for Surgery, Obesity and Metabolism (SASSO). Motivations must include a surgical evaluation and reports from all other relevant team members.” This clearly pre-empts that there still is a plan option that covers this surgery - obviously the highest plan, being the Comprehensive Plan.

Prior them changing the fund Rules to exclude bariatric surgery it was clearly mentioned all over the internet that ONLY the Comprehensive Plan would qualify for consideration of the surgery with pre-authorisation. The official document under GUIDLINES supports this view up to today on their website.

Doing a simple search all over the internet it is clear that basically none of the doctors offering bariatric surgery is aware of these recent exception change and one can only speculate that they have never been informed of the change thereof. It is still published that Bonitas will approve and cover the cost if you are on the Comprehensive Plan. Many prospective patients for this type of surgery would be (un)pleasantly surprised that Bonitas will just point blank refuse to pay a dime for this surgery and that they have to fork our at least R100 000 – R150 000 for the surgery (and this 2 days before surgery!) The information on the Bonitas website is misleading the public and their members and members opt for the most expensive Bonitas option in bona fide anticipation that they would cover the cost only to be disappointed and frustrated. REF: BON ********** 1