Dodging the bullet on PMB surgical authorisations

I am outraged, aggrieved and at a complete loss when it comes to dealing with Bonitas and surgical authorisations.

My wife was diagnosed with breast cancer several years ago. She has been registered as a cancer patient with Bonitas under code C50.9.

She underwent surgery to obtain a biopsy sample that confirmed it was cancer. Cancer confirmed, she underwent a partial mastectomy of her left breast. Six months later she suffered though 30 rounds of radiation over 6 weeks. Six months later she was ready for the first round of reconstructive surgery.

Application for authorization of surgery was declined. We had to jump through many hoops and undergo unnecessary medical expenses forced on us by Bonitas. Having provided all the details requested in the first refusal and again they refused to authorise, having found a new reason to decline.

Again, we had to provide information and detail already at their disposal at this point. Again, we took the time and effort to provide what they requested. Again, they declined without any good reason and this forced me to report them and they deliberate delaying tactics on HelloPeter.

Within hours of reporting them, they contacted me to tell me that they would urgently reconsider the case. Early the following morning the surgery had been approved.

In good faith, I removed the post from the platform.

In terms of the very spirit of Prescribed Minimum Benefits, my wife is currently physically deformed due to the partial mastectomy on her left breast and an extremely obvious mismatch in size between right and left, along with several other issues with her right breast.

An application for approval of an absolutely necessary second round of breast reconstruction was submitted to Bonitas on the 18th December 2023. Surgery was scheduled for 18 January 2024 and the operating theater booked.

By the 9th January there had been no response from Bonitas. A call was placed to query the lack of response and later the same day, the application was declined (what a surprise) due to “insufficient clinical information”. Once again, they have all of Natasha’s clinical records from years of surgery and applications and records. This time they wanted a sonar. A further waste of my medical aid benefits. The sonar was submitted. Now (and this is becoming repetitive) they have declined once again. Surgery has been rescheduled for 1 February 2024. Their excuse this time, and I use the word excuse very deliberately, is that my wife, under the current and ongoing care of her plastic surgeon, is that we had not gone to our GP / Specialist to obtain referral to visit the Plastic Surgeon who has now operated on her twice.

In their email to my wife declining her reconstruction, they also notified her that she is NOT registered as a cancer beneficiary and is not entitled to these benefits after having been a REGISTERED cancer patient for more than 2 years. ***?

After all of these experiences and difficulties with Bonitas, it is my personal opinion that what they are doing to us, is happening to all of their members, and that this is a premeditated and carefully thought-out strategy to defer as many surgeries for as long as they can in order to minimize their financial exposure and beef up their balance sheet.

The cost to us and a great many other Bonitas members is incalculable in terms of pain, psychological and emotional trauma and unnecessary expense and stress.

The psychological impact of having discovered that she has cancer was bad enough. Her current physical state is so bad that we have many times asked the question “What is it that we have to do here? Do these people want us to send photographs of what her chest looks like before they will listen? Do I have to obtain reports from a psychologist and a psychiatrist to show them her mental state?”

The pain that she has suffered 24/7 literally ever day would drive many people to a pain medication addiction.

Let’s talk about emotional wellbeing and loss of confidence. This is a serious deformity, people. Do they give a tiny little rat’s ass about any of it? NO. As long as they collect one third of my net pension every month, they are happy.

Enough is enough and here we go for round 2 in HelloPeter.