Confusing claims process
My wife went for a nk cells blood test on 18 May 2013 through Ampath. Got an email saying Bonitas is paying R346.40 of R1385.60 due to the benefit being depleted. Firstly, no-where under my Benefits does it show where this is coming off of. So we phoned Bonitas and a lady said that it is coming off a Chronic Benefit. How can a blood test be under Chronic? It should be under the pathology benefit. Secondly, the lady says they are rejecting it because it is duplicate tests, which it is not. There are 4 different tests, just under the same tariff code. So now she says that that is why it wasn't paid in full from Bonitas side. So what must I do now??? DO NOT PHONE ME. EMAIL ONLY.
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Replies (4)
Bonitas Medical Fund's replyOfficial
24 May 2023, 14:55Hello Charl G
Thank you for notifying us of your complaint. We are so sorry to hear about this, we are glad that you brought this to our attention to resolve.
We are investigating this matter.
We appreciate your patience while we are resolving this query for you.
Kind Regards
Bonitas
Thank you for notifying us of your complaint. We are so sorry to hear about this, we are glad that you brought this to our attention to resolve.
We are investigating this matter.
We appreciate your patience while we are resolving this query for you.
Kind Regards
Bonitas
Best regards,
Bonitas Medical Fund's reply24 May 2023, 14:55
Official
Hello Charl G
Thank you for notifying us of your complaint. We are so sorry to hear about this, we are glad that you brought this to our attention to resolve.
We are investigating this matter.
We appreciate your patience while we are resolving this query for you.
Kind Regards
Bonitas
Thank you for notifying us of your complaint. We are so sorry to hear about this, we are glad that you brought this to our attention to resolve.
We are investigating this matter.
We appreciate your patience while we are resolving this query for you.
Kind Regards
Bonitas
Best regards,
's updateReviewer Update
26 May 2023, 12:44Still waiting on a response via email.
's update26 May 2023, 12:44
Reviewer Update
Still waiting on a response via email.
's updateReviewer Update
26 May 2023, 14:25The reply via email is not satisfactory. Just a repeat of why it was rejected. What is the "Managed Care Programme Benefits" and why is it coming off of that? It is not a chronic condition. This should be coming off under Pathology! Also, the four tests with the same tariff codes are not the same tests, they are just under the same tariff code as they cost the same price. I need management to intervene urgently.
's update26 May 2023, 14:25
Reviewer Update
The reply via email is not satisfactory. Just a repeat of why it was rejected. What is the "Managed Care Programme Benefits" and why is it coming off of that? It is not a chronic condition. This should be coming off under Pathology! Also, the four tests with the same tariff codes are not the same tests, they are just under the same tariff code as they cost the same price. I need management to intervene urgently.
's updateReviewer Update
08 Jun 2023, 15:59 The reply via email is not satisfactory. Just a repeat of why it was rejected. What is the "Managed Care Programme Benefits" and why is it coming off of that? It is not a chronic condition. This should be coming off under Pathology! Also, the four tests with the same tariff codes are not the same tests, they are just under the same tariff code as they cost the same price. I need management to intervene urgently.
's update08 Jun 2023, 15:59
Reviewer Update
The reply via email is not satisfactory. Just a repeat of why it was rejected. What is the "Managed Care Programme Benefits" and why is it coming off of that? It is not a chronic condition. This should be coming off under Pathology! Also, the four tests with the same tariff codes are not the same tests, they are just under the same tariff code as they cost the same price. I need management to intervene urgently.