VH
Varima H

1 reviews | Active since May 2019

27 May 2019, 11:01

Denied Maternety hospital auth

I would like to raise a query and escalate this issue and maybe try and get some assistance. I am trying to get a pre-auth for delivery for my spouse. I am running into an issue where the underwriters declined my pre-auth due to not disclosing that my spouse was pregnant when I added her to the medical aid.

I did disclose that she was pregnant on the forms and I was not advised of any benefit waiting period, had I have been advised I would have had more time to prepare for this. We even started using some of the consultation and scan benefits we have on the plan. I would like to get a better understanding of why :

a. I was not advised of the benefits waiting period? b. Why we were able to get some benefits and denied the delivery?

0
Replies (4)
Bonitas Medical Fund
Bonitas Medical Fund's reply27 May 2019, 13:24
Official
Hello VarimaHenry1,
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
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Varima H's update28 May 2019, 13:30
Reviewer Update
This is an extremely time sensitive matter and I have not been contacted yet. It's been more than 24 Hrs. I am escalating this matter to the Consumer Goods And Services Ombud and willing to take legal action if my child is born in a public hospital while I am paying "medical aid with maternity benefits."

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

Awaiting your response.
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Varima H's update29 May 2019, 10:16
Reviewer Update
Good day 
After back and forth trying to figure out whites happening with the non disclosure issue that caused my hospital auth to be denied i have figured out what the issue is. I completed two forms because the fist one that I was given was “Outdated” on the second form I made an error of not completing this section as intended on the first form. This non disclosure was not deliberate and a real error from the back and forth caused by sending wrong form in the first place.
May you please assist by considering this in your investigation as this was not a deliberate non disclosure.
I have attached the email conversation below and the two completed forms. You may use the emails in the conversation below to verify the conversation.
RegardsVariman Henry 



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Varima H's update04 Jun 2019, 13:20
Reviewer Update


Good day.
I am following up on an issue that i need assistance with urgently. My maternity pre-auth was declined due to non disclosure of the pregnancy when i app****, I letter discovered that the was an error made when i was filling in the back and forth process of filling out the forms at work as i was sent an outdated form to initially complete. 
Attached are the two forms and I have forwarded the email communication around the wrong form being sent to Bonitas  see copy below. I have gave the people doing the investigation to verify that this was what happened with the application.
I would like to bring the following to the investigative teams attention :
1. The non disclosure on the second form was an honest error as you can see  I had disclosed the pregnancy on the first form that was later discovered to be outdated.
2. I am using Bonitas from a work capacity and not my own personal capacity. form previous experience in other companies i have worked for, waiting periods and late joiner fees usually do not apply. 
3. Since i am subscribed to bonita from work i cannot easily change my plan or service provider to rectify this issue and get immediate cover for the birth of my child as with other service providers.I understand my query has been escalated to the members department and i wanted to give you the full story so you can assist me urgently. 
I have provided the documents and the email conversation to verify what happend. 
Awaiting your response.