BONITAS NIGHTMARE

I am a member of the Bonitas Medical Aid and because of my low income, I am on the BonCap Option Plan. Because of problems with my eye’s (40 % sight in the left and 60% in the right eye) I had to have a lens transplant. I made an appointment at the Pretoria Eye Institute in 3 March 2022 for a consultation and scan (Dr Kunzmann), and the operation was booked for 7 April 2022. The Surgeon’s office then contacted Bonita’s for authorisation. On the 30th of March (Thursday) we received a call from the Dr’s office to say that my co-payment would be R 10,360 because the Eye institute is not on the Bonita’s network. We immediately called Bonitas to find out which Hospital and Ophthalmologist is on their Network. We were told that Bonitas do not have such a service on their Network and that my case would need to be escalated to some department to have the co-payment waived. The Bonita’s agent undertook to call us back. Nobody from Bonitas called back and we followed up on Friday (1 March), Monday (4 April) and Tuesday (5 April) and every time we heard the same story that the claim need to be escalated because there is no hospital in Pretoria on their network. We were then told around 5 April that Bonitas did have Montana Hospital on their Network. We were also told that Bonitas have an Ophthalmologist (Dr Niemand) but he/she does not operate at Montana Private Hospital. We later found out that this Dr Niemand that is on their Network has Immigrated to Europe. (Hearsay not confirmed) We were further informed that the Ophthalmologist that do operate at Montana (Dr van der Merwe & Dr Meyer) is not on the Bonitas Network and would also require a co-payment. Since it was now 2 days before the scheduled operation, I had no choice but to go ahead with the operation at the eye institute with Dr Kunzmann and accept the R 10,360 co-payment. Every time we called Bonitas we were put on hold for even up to 40 minutes and never received a clear answer. Nobody called back. They eventually found that they had an Ophthalmologist on their Network but not a hospital, and a Hospital on their Network but not an Ophthalmologist. This was a total NIGHTMARE and unprofessional conduct by a reputable Medical Aid like Bonitas. I have to say that after the lens transplant my left eye is absolutely wonderful and I can see clearly once again. I still have to have a transplant in my right eye but I shiver if I think I have to go though the Bonitas ordeal once again.