Illogical and unreasonable scheme rule

<p>I received a referral letter from my GP to a Paediatric Gastroenterologist. I paid cash to the provider. The day after the visit, I called the Bonitas call centre about a different unpaid claim but was also informed that my doctor did not phone in to get approval for the referal to the Paediatric Gastroenterologist. If I dont have the referal number, Bonitas will not pay. I phoned the doctors office, and the got me the referal number. bonitas then subsequently rejected my claim. How is it possible that I am a contract holder but payment of my claim is dependent on a third part (my doctor) getting a refereal number. If he doesnt, my claim is not paid. All correspondece form Bonitas indicate that I need a referal letter but nowhere does it state that I need a referral number. This rule only benefits Bonitas and gives them an added reason to reject claims and as the consumer and contract holder, I have no say. A second claim for the educational psychologist was rejected: no attachment on claim. Yet, when I phoned in about it, the agent in question could access the attachments. I pay close too R4000 a month (R48000 pa) but have access to less that R10 000pa in day to day benefits. When I do claim, Bonitas does everything they can not to pay claims or delay claims. Please pay my two claims</p> <p> </p>