Extremely poor service regarding an outstanding balance and claims query

<p>Dear Bonitas</p> <p> </p> <p>I have been a client with Bonitas for almost 8 years. I have changed employers twice and I have elected to stay with Bonitas on both occassions because I was satisfied with the cover and service that Bonitas provided in the past.</p> <p> </p> <p>OUTSTANDING BALANCE ISSUE:</p> <p>That all changed when I joined a new employer in April this year. Once again, I elected to stay with Bonitas however I required a member swop. My wife was the principal member and I needed to be the principal member when joining my new employer. I was advised to complete the forms for a new membership number so that the member swop could be completed. Very long story short, Bonitas was required to refund me for a contribution that I made in advance for my old membership number. It took almost two months for them to refund my contribution. Bonitas then only refunded a portion of my contribution after indicating to refund the full amount, and I am still waiting for a reason why an outstanding debt on member's portion amount was deducted from my refund. I have had to follow up on a weekly basis at the start to try and get feedback, but the person investigating the issue has not yet got back to me with the reason. This feedback has been outstanding since the end of June 2016.</p> <p> </p> <p>POOR CLAIMS SERVICE:</p> <p>I submitted a claim for a GP visit on 8 July 2016 but it was just the invoice and proof of payment. I then had to follow up on 25 July 2016 to see why the claim was not processed. I was then told that it had to be an account statement (I can't believe that Bonitas does not reply saying that the information is not correct, why should I have to follow up? I think that it would be a good service to deliver to the client). I then submitted the claim again on 26 July 2016 with the account statement. I then see that only two out of three claims in the same email was processed on 4 August 2016. I then had to follow up again on why the third claim has not been processed on 11 August 2016. I was then told that an account statement with the "codes and ICD 10 codes" were required. The same account statement was then sent again to the consultant because I believed the statement did have the required codes. I then received an email from a different consultant on 12 August 2016 saying that the claim requires the following information, "Please check that your account shows the following: practice number, your name and initials, your medical aid number, the treatment date, name of patient, the amount charged, tariff and ICD-10 code. Check that prescriptions for medication show all your details, also check that the correct quantity of medication dispensed is shown on the claim.". I have now taken the same account statement and highlighted the relevant information in yellow and sent it for a third time to Bonitas on 12 August 2016. Why should I have to submit an account statement three times in order to process a claim?</p> <p> </p> <p>What is going on at Bonitas? Do the different departments not talk to each other? Is Bonitas closing queries prematurely with superficial feedback to clients to positively influence their service statistics? Is the claims department not evaluating the claims properly for the required information? Will it not be better for everyone if Bonitas offered quality service? It will reduce the effort required for both parties and the cost of providing this service.</p> <p> </p> <p>I encourage Bonitas to go look at my old and new membership numbers to see how many times I have had to contact them for the above two issues alone. Bonitas can contact me for my membership details.</p> <p> </p> <p>I further encourage a service manager at Bonitas who cares about making a difference and delivering a quality service to a client to call me so that they can resolve what I believe are two really easy issues to get fixed.</p> <p> </p> <p>I am now seriously considering switching to another medical aid provider in search for better service.</p> <p> </p> <p>Regards</p> <p>Sashen</p>