Disillusioned and frustrated member

Once again Bonitas have failed a loyal, paying member.

My husband underwent a shoulder operation in December 2021 to remove metastasized cancer on his scapula which has severely impacted his mobility and function.

After 78 days, we still can't get a straight answer from Bonitas as to why the specialists claims were short paid.

-First the histology report was requested and submitted, and claims rejected. -We lodged a dispute with the required specialists motivation attached. - Upon querying the outcome after a week, we were told that the dispute process takes up to 10 working days. - Queried again after 10 working days, only to be told that Bonitas forwarded the dispute to the wrong department. Another 3 working days waiting period. - A week later, we're being told that the ICD code claimed is not a PMB condition and the specialist should resubmit their claim with the correct ICD code. - Yesterday, Bonitas changed their story and is now saying that the correct ICD code (same code as above) is showing on the hospital authorization letter but that the specialist did not include this code on his billing. Bonitas advised that the original ICD code is one of the PMB conditions and the specialist is part of their doctor network. The service advisor could not understand why this claim was not paid in full. Their advice after an 1 hour telephone conversation - the specialist must include this ICD code on his billing and try to submit again.

How many times does this claim have to be re-submitted? And why are we being told multiple, contradicting reasons why the claim is not being settled in full as this operation was done as part of palliative cancer care which is considered a PMB condition and a DSP was used (my husband is registered on the cancer programme).

Quoting Bonitas: "The Oncology Management Programme offers members diagnosed with cancer emotional support and manages your oncology benefits on your behalf. The cancer programme puts you first and delivers cost-effective care of the highest quality." Please let me know how my husband's needs have been placed first throughout all this stress? He's at the point where he wants to cancel the medical aid and take his changes with a state hospital facility - where is the emotional support for a stage four cancer patient now?

Shame on you Bonitas for adding more unneeded stress in an already stressful time.