1 reviews | Active since Dec 2009

05 Jul 2018, 11:10

Claim rejected and not able to justify it with Scheme rules

Item: Bonitas Medical Fund
Rating: 1
Author: Des P

Bonitas refuses to pay for blood test (Vitamin D) for an amount of R190.10. They requested a letter of motivation from the specialist.

They expect a patient to pay specialist consulting fees in order to get a letter of motivation for a test that costs R190! Now Ampath is threatening to hand over to legal.

I have asked Bonitas to provide me with the section in the Scheme Rules/Annexures where it states a motivation letter is required for this specific blood test and was promised this would be provided 2 weeks ago by Nomphumelelo (who contacted me after escalation when I did not receive a response after 1 month).

Why does it take almost two months to provide the rules? If you cannot provide the rules/annexures as approved by CMS then you are obliged to pay for the test. You simply cannot create your own rules to justify rejecting a claim

My original query was logged almost 2 months ago. Surely this is NOT acceptable service?

Helpful (0)

Replies (7)

Bonitas Medical Fund's replyOfficial

06 Jul 2018, 11:04

Hello soldier,

Thank you for submitting your details to us through Hello Peter.

This is to confirm that we have received your information and that we are currently investigating this matter.

Our representative will be in touch with you shortly to discuss this matter and ensure that it is speedily resolved.

Kind regards,

Bonitas Team

Bonitas Medical Fund's reply06 Jul 2018, 11:04

Official

Hello soldier,

Thank you for submitting your details to us through Hello Peter.

This is to confirm that we have received your information and that we are currently investigating this matter.

Our representative will be in touch with you shortly to discuss this matter and ensure that it is speedily resolved.

Kind regards,

Bonitas Team

Bonitas Medical Fund's replyOfficial

10 Jul 2018, 13:24

Hello soldier,

As per our email communication your query is still being investigated and we will keep you updated until the matter has been resolved.

We appreciate your patience while we are resolving this query for you.

Regards,

Bonitas Team

Bonitas Medical Fund's reply10 Jul 2018, 13:24

Official

Hello soldier,

As per our email communication your query is still being investigated and we will keep you updated until the matter has been resolved.

We appreciate your patience while we are resolving this query for you.

Regards,

Bonitas Team

Des P's updateReviewer Update

10 Jul 2018, 13:32

It's being investigated for the past 2 months as per my complaint. Your email to me now has no new information. The same information that has led to this complaint. Does it take 2 months to provide the rules? The CMS approved rules, not rules that are being written now by your pathology department over the past two months.

Des P's update10 Jul 2018, 13:32

Reviewer Update

Des P's updateReviewer Update

10 Jul 2018, 13:35

What do I tell Ampath now? That Bonitas Pathology department won't pay and won't provide me with the CMS approved rules that they use to reject the claim? its' R191 - settle the account while your pathology department writes these new rules.

Des P's update10 Jul 2018, 13:35

Reviewer Update

Bonitas Medical Fund's replyOfficial

11 Jul 2018, 15:16

Hello soldier,

Thank you for submitting a comment to us through Hellopeter.

According to the email communication, we hereby confirm that your concern has been addressed and this matter has now been resolved.

As Bonitas we strive to give the best customer service to our clients and appreciate it when you bring your concerns to our attention when we have failed to deliver this service.

We apologise for any inconvenience caused to you.

Thanks and regards,

Bonitas Team

Bonitas Medical Fund's reply11 Jul 2018, 15:16

Official

Hello soldier,

Thank you for submitting a comment to us through Hellopeter.

According to the email communication, we hereby confirm that your concern has been addressed and this matter has now been resolved.

As Bonitas we strive to give the best customer service to our clients and appreciate it when you bring your concerns to our attention when we have failed to deliver this service.

We apologise for any inconvenience caused to you.

Thanks and regards,

Bonitas Team

Des P's updateReviewer Update

11 Jul 2018, 15:30

The concern is not addressed. You have emailed me (from a no reply address, so I cannot reply) a small printout that is not Council for Medical Schemes approved. If it was CMS approved there would be a CMS stamp on it and it would be available as rules / annexures on your website. Why did it take 2 months to provide this "flyer" and why isn't it approved by CMS or in your rules and annexures? You cannot provide some non-CMS approved flyer and use it to justify rejecting a claim.

Des P's update11 Jul 2018, 15:30

Reviewer Update

Bonitas Medical Fund's replyOfficial

20 Jul 2018, 11:43

Hello soldier,

Thank you for submitting a comment to us through Hellopeter.

According to the email communication, we hereby confirm that your concern has been addressed and this matter has now been resolved.

As Bonitas we strive to give the best customer service to our clients and appreciate it when you bring your concerns to our attention when we have failed to deliver this service.

We apologise for any inconvenience caused to you.

Thanks and regards,

Bonitas Team

Bonitas Medical Fund's reply20 Jul 2018, 11:43

Official

Hello soldier,

Thank you for submitting a comment to us through Hellopeter.

According to the email communication, we hereby confirm that your concern has been addressed and this matter has now been resolved.

As Bonitas we strive to give the best customer service to our clients and appreciate it when you bring your concerns to our attention when we have failed to deliver this service.

We apologise for any inconvenience caused to you.

Thanks and regards,

Bonitas Team