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TN
Tanya N

1 reviews | Active since Dec 2016

19 Jul 2023, 09:47

Claim rejected

My husband has been with Bonitas since 1999 and have always had good service. He got sick recently, visited the GP who treated him and advised if he not getting better he needs to see a specialist. The course of medication finished from the GP and he was not better so he phoned the specialist and was told a referral letter from the GP is not required. Payment to the specialist is cash and you claim from the medical aid. My husband submitted the specialist bill to Bonitas, we received an email advising it is being processed. After a month we had no feedback, my husband phones Bonitas and was told the claim was rejected because he did not have an authorization number from Bonitas. Bonitas has alot of rules which we have no clue about and you find out the hard way especially when you sick and you think your medical aid will cover you.

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Replies (4)
Bonitas Medical Fund
Bonitas Medical Fund's reply19 Jul 2023, 09:53
Official
Hello Tanya N
     
Thank you for notifying us of your complaint, we are sorry to hear about this, we are glad that you have brought this to our attention. 
         
Kindly provide the membership number or ID number of the principal member privately (to protect your personal information not to be visible on this public forum) to investigate your enquiry. 
          
 Kind regards
     
 Bonitas Team 
 
Bonitas Medical Fund
Bonitas Medical Fund's reply19 Jul 2023, 11:29
Official
Hello Tanya N
 
Thank you for submitting the details to us through Hello Peter.
  
We will investigate this matter. 

We appreciate your patience while we are resolving this query for you.  
 Kind Regards
 
 Bonitas Team  
TN
Tanya N's update25 Jul 2023, 07:17
Reviewer Update
Thank you, the reply received from Bonitas contradicts what we were told as per the telephonic conversation with Bonitas after a month of no feed back on the claim . The GP advised my husband needs to see a specialist, so we can get the letter from the GP uploaded to Bonitas. When we phoned Bonitas we were told we have to phone in for an authorization code to see a specialist. So is a code required or a letter from the gp needed for the claim to be paid????
On the reply received from Bonitas dated 24 July 2023, please see below:
With reference to your enquiry, please be advised that on the Standard and Standard Select Options a member or beneficiary will be required to obtain a referral from a registered general practitioner for a specialist consultation. However, should a member/beneficiary not have a referral, the claim will not be covered. The specialist referral authorisations are valid for 6 months per practice type. Please refer to the attached brochure and guide on how to register for a specialist referral authorisation.

Please advise on the way forward.
TN
Tanya N's update25 Jul 2023, 07:19
Reviewer Update
Reference number: 190723QRNN5Z on the above email received.