DISORGANISED AND POOR SERVICE AND COMMUNICATION

Specialist Authorisation provided on 28 September 2023 which is valid from 28/09/2023 up to 16/12/2023. I repeatedly contacted your company via Telephone and e-mails on 03/10/2023, 04/10/2023 and 05/10/2023 prior to the visit to the specialist to disclose the amount payable to the Specialist and whether it will be covered in full by the medical aid. I was repeatedly advised that the account will be paid in full as the authorisation is under the PMB Chronic benefit. The invoice for R4 500.00 was paid upfront by myself and submitted to you for refund on 10/10/2023. Your first communication on 16 /10/2023 is that only R2 931.70 will be paid as no specialist authorisation was obtained upfront, even though the authorisation was provided on 28/09. The last communication received today 17/10/2023 is now that only R1 065.07 of the R4 500.00 will be paid and that R3 434.93 is rejected due to depleted benefits.

How do you provide authorisaiton upfront without checking available benefits? How do you provide authorisation to the member without confirming the actual benefit amount available in the communication. I have repeatedly called and e-mailed before going to the specialist requesting confirmation of cover, at no point to you disclose or indicate that the benefit amount is nearing depletion.

I require that you send me all the phone calls with your staff relating to this matter as I will be lodging an official complaint with the relevant regulatory body.

Submitting claims with Bonitas is actually a full time job due to poor service. Went to see the Specialist that is on your panel on 10/10/2023 which is still within the validity period.