Bonitas Not Paying According to Scheme Rates – Urgent Resolution Required

I am a member on the BonStart option and am experiencing ongoing issues with the short payment of claims, despite following all the correct procedures and receiving pre-authorisation where required.

For GP consultations, my co-payment is R125. The full consultation amount charged by my GP is R571.50, with the Bonitas Scheme Rate listed as R446.50. Up until 12 May 2025, this was paid correctly – Bonitas covered R446.50 and I paid the R125 co-payment.

However, since then, both my wife and I have seen the same GP, and Bonitas has only paid R357 per consultation. This is R89.50 less than the scheme rate. I’ve been repeatedly told that Bonitas pays according to the scheme rate, but clearly this is not the case. This discrepancy has occurred on at least three separate visits.

In addition, I consulted with a Specialist after obtaining pre-authorisation from Bonitas. The Specialist charged R1100. The Scheme Rate for this consultation is R509.70, yet I have been told Bonitas will only be paying R244.70. I paid the full R1100 upfront and submitted the claim expecting reimbur*****t in line with the scheme rate – not a significantly lower amount.

I have called the call centre numerous times, had the matter escalated, and was told most recently that the system was offline. Despite all this, the problem persists with no feedback or resolution. I am now tired of being given the runaround while continuing to pay more than I should out of pocket.

I have the claim numbers, pre-authorisation reference, and supporting documents on hand but will not share them publicly. Bonitas, please contact me directly to resolve this matter urgently.