Don't have a baby on Bonitas

I have been a member of Bonitas medical fund since 2019. I very recently had the misfortune of having a baby whilst being on this scheme. November 2022 I found myself in the emergency ward as I nearly miscarried my baby at 6 weeks. I was bleeding and rushed to the nearest hospital. As you can imagine the experience was traumatic. Once the bleeding was stopped a heartbeat could not be found. Eventually the on call gyny (dr Mtambo) found the heartbeat of my baby. I was sent home with medication. The following day I returned with bleeding again. This time to be admitted. I was allowed to be admitted as Mercantile hospital as there was no gyny on call at Greenacres hospital (my network hospital) As a result co payments would be waved etc. When I was discharged the claims started rolling in. Most rejected. This was a a threated miscarriage , possible loss of life . As I understand this is PMB.. After numerous fights ,resubmissions of claims , long telephone calls with the medical aid and hospital made by myself the claims were settled. All except 1. This particular doctors office went over a year with no communication regarding this 1 claim. In January 2024 they emailed me regarding payment. I contacted my medical aid and was told the doctor should have requested authorisation which I then communicated to them. I was told Bonitas would not look at the claim unless the doctors office called and resubmitted it. The doctors office then refused and handed the account over to able tracers who have now added a further R700 to the bill. My problem, the doctors office did not follow a process to even arrange for this bill to be paid with me for over a year. When I called bonitas authorisations as I was asked to by their call centre staff to do I was told the claim is stale and would not be paid as it was my responsibility while I was bleeding from a threated miscarriage to call and request authorisation even though this was an emergency. How can a claim be stale if it was received by the medical aid previously? Secondly if your call centre staff don't know who must request authorisation how the heck must your member know ????????And in an emergency? Surely the codes should guide you??? I am still waiting for a team leader or some person to call me back regarding this. To date nothing........... I have had nothing but constant issues when it comes to actual valid payment and a fight must ensue from my side to get valid bills paid. I pay over R4000 a month in medical aid which i don't even use every month. At the very least emergency situations should be handled with care. For my planned c section at their hospital , using their network provider which i had to change because the network hospital was changed during my pregnancy, they also tried to get away with paying a fraction of the in theatre bill which was planned , which I had authorisation for. While i was taking care of my newborn i also had to fight for this bill to be payed. This was my third pregnancy. All 3 of kids were delivered whilst i was on a medical aid scheme. This was by far the worst experience I have ever had. A time of celebration and joy was marred by these constant battles, telephonic costs for my account and a constant anxiety over what they would refuse to pay for next. Now the baby is 8 months old and requires umbilical hernia surgery and I have been told to use their provider and hospital over 300 kms away because they will not cover the surgeon at the hospital in my city. Will they pay my accomodation, fuel , the costs for the follow up visits? Why the hell do i pay for medical aid to sit with a myriad of out of pocket expenses. Bottom line if you need to visit a gp you are fine , any other significant life changing event prepare to be greatly out of pocket with Bonitas medical fund. They cherry pick what PMBS and emergencies they will pay for. The call centre staff is grossly *********** the member bears the brunt of all the incorrect information supp****. Who the hell must pay this R2000 BILL I am now being hounded for and every dam month you get your money for providing no service. I will be reporting this to council of medical schemes.