Claim Rejection By Bonitas

I am writing to express my deep concern and seek clarification regarding the recent rejection of my claim. I hope this letter finds you well. I am writing to express my dissatisfaction with the recent rejection of my claim for medical services received at DR SAUERMANN & PARTNERS on [25 August 2023]. I believe it is crucial to bring this matter to your attention for a fair and prompt resolution.

On the mentioned date, I sought medical attention at DR SAUERMANN & PARTNERS due to an illness I experienced while at work in Pretoria. Regrettably, Bonitas rejected the claim, citing the use of a non-nominated GP as the reason. I wish to emphasize that both of my nominated GPs are located in Benoni and Midrand, making it impractical for me to seek immediate medical attention from them at that specific time.

What is particularly perplexing to me is the apparent lack of application of the Treating Customers Fairly (TCF) principle in this instance. It seems that the current policy implies a requirement for individuals to be permanently stationed at their place of residence for claims to be honored and paid. This expectation becomes impractical, especially in urgent medical situations where immediate attention is necessary. I am disappointed that Bonitas did not consider the unique circumstances surrounding my situation when evaluating the claim.

As a member of Bonitas Medical Scheme, I pay my premiums diligently every month, expecting fair and reasonable coverage in return. Unfortunately, the rejection of my claim has left me disheartened, as it implies that the system failed to recognize the urgency and necessity of my medical situation.

To address this issue, I kindly request the scheme to reconsider and honor my claim. I have attached copies of the relevant receipts for your reference. I believe a fair and empathetic review of my case will demonstrate the need for a compassionate and flexible approach in evaluating claims.

I anticipate your prompt attention to this matter and a resolution that reflects the commitment of Bonitas Medical Scheme to providing quality service to its members. I will await your response within the stipulated turnaround time before considering alternative avenues, including contacting the Ombudsman.

Thank you for your understanding and cooperation in resolving this matter.