Claims Processing

1 Comment Sort by Newest

Add a comment...

Jacqui Steenkamp I am not sure if it is even worth spending time on making you aware of this saga with Bonitas...... It is impossible to get good service from this medical aid. I am really desparate by now..... so here goes.....

1 My mom (85 years old) had to go for a hip replacement in November 2018. She was required to to go to a sub acute facility after the operation. Medwedge in Norhtcliff.

2 Bonitas did not approve this due to the Dr applying for the wrong facility. We thus paid cash and I decided to get this rectified afterwards. 3 In Dec 2018, after numerous conversations with the Dr's rooms, the hospital and Bonitas, the correct information was passed to Bonitas and the Sub Acute treatment was approved in early 2019.

This is where (as far as Bonitas is concerned) everything stopped....

4 To cut a long story short...after hours on the phone to Bonitas as well as several email complaints, I eventually found out that the ICD 10 codes submitted by the sub acute facility was wrong....I only got this information from Bonitas, by literally spending HOURS on the phone to the claims department and even speaking directly to the case manager at Bonitas. I eventtually got a senseable email from Bonitas to explain the problem.

5 However, NO luck after that. The subacute facility submitted the correct claim with the correct ICD 10 codes in May 2019.

6 The subacute facility again submitted the claim in June 2019.

7 By 12 August 2019, I asked the subacute facility to agian submit the claim, obtained proof that it was submitted and called Bonitas.........on 12 August 2019 I spent over 4 hours on the phone to Bonitas and had to speak to 4 different people, was told the claim was not submitted (while I had the proof in my hands), and even spoke to the case manager, that informed me that the claim was received via mail, but no one processed it. Another month gone.... The case manager then ensured me that the claim was now submitted to the claims department for processing.

7 AND I heard nothing after that...... so, almost 2 weeks later I had to, once again, contact Bonitas to follow up. I sent a mail to the claims department, again attaching all the the relevant documentation and guess what........A day later (today 23 Aug 2019) and I am informed that the claim is once again refered to a different department for processing.... Note I only get ANY communication from Bonitas if I initiate it and this after numerous complaints and hours of conversation.

So what I need to know is: 1 Is there anyone at Bonitas that can take ownership of this issue and resolve it. And I mean make sure that is completely taken care of in stead of referring the matter to different departments? Or is this a strategy to delay the process, frustrate the customer and hope the customer gives up? Well please note that I am NOT giving up!!!

2 Will there be interest be paid to me on the R11000,00 rand that Bonitas is gladly keeping in their account while delaying this claim?

I suggest Bonitas seriously look at the business processes within the company as it is not working at the moment!!!

Latest reference numbers from Bonitas: 190819QL2FRM 190819QL2FR1 member Number: ***

Let's see if this can get resolved.....I am not giving up!

Kind regards

Jacqui Steenkamp Like · Reply · 1h Facebook Comments Plugin