Bonitas Shifting PMB Costs to Members Despite Using a DSP

I finally received written feedback from Bonitas confirming that they do not pay PMB claims in full and that any shortfall is not covered by my scheme option — even when using a DSP.

This is extremely concerning. PMBs are statutory benefits, and my understanding is that the scheme option should not be used to shift legitimate PMB costs back onto the member.

What is even more concerning is the apparent pattern of PMB claims being declined or partially paid when specialists submit them electronically, despite the member using a DSP.

How can these regulations have existed for years, yet members are still being left with costs that should be covered under PMB? I am now questioning whether this is simply an administrative failure or whether the claims process has been structured in a way that shifts PMB costs onto members.

I believe this matter deserves investigation by the CMS and potentially by the media. Bonitas should clearly explain the regulatory basis for this practice rather than simply referring members to their scheme option. Bonitas your CEO is going to answer this question because from here we heading to the media