Inconsistent Claims Process / Inadequate Customer Service

I am now lodging a formal complaint against Bonitas for consistent human errors which occurred for a recent claim submitted.

On the 12 November 2020, I had paid for Psychology Health and submitted the claim via your WhatsApp Claims process.

Human Error #1: The invoice submitted clearly indicates the “approved” payment receipt, including a clear image of the word PAID in red, stamped on the invoice. The person who picked up this claim through your WhatsApp service incorrectly processed this claim, and the reimbur*****t amount was processed to be paid to the Vendor and not to the Member. On the 19th November, when I went back to the Vendor for another service, the expectation was that I would have had the monies in my account to pay for this particular service, which upon checking my bank account, realised that only the 1 claim amount was paid into my account, and not the R1150.00 claim that I submitted on the 12 November. Acknowledging the error on the sms, I made an arrangement with the service provider not to pay cash for the service, as the Medical Aid sms indicated that a payment was being made within 3 days of 19Nov to the Provider and I would have a credit to my account – so I accepted those terms. “Claim for MRS MG ROGERS M G dated 12/11/2020 has been processed. R1150.00 will be paid to the provider within 3 days from 19/11/2020 – Bonitas”

Human Error #2: I contacted the Bonitas Contact Centre and spoke to call agent Siphiwa. I advised him of the error, and asked him WHY it happened. He advised me to hold on to the call for him to engage with the Claims department. Now firstly, I would highly advise that he be coached on how to speak clearly on the call to customers, as the quality of the call was unacceptable. He further advised me that he was transferring me to the claims department, and mentioned something about rectifying the claim. I’m like OK. During this time, the contact agent informed the Claims Agent that I wanted the claim reversed. It is very clear that the contact agent did not take the time to listen to my query, and took it upon himself to relay an instruction without my instruction or consent.

Human Error #3: I was transferred to the Bonitas Claims Centre and spoke to Lesego. Upon instruction from Siphiwa, she relayed my issue back to me, and further informed me that she went ahead and reversed the claim that was supposed to be paid to the Vendor, and is now going to be paid to me, the Member, and that I will need to wait another 7-14 days for the reimbur*****t. Now, Lesego did not take the time to first validate my request and reason for calling in the first place, which was to understand why the claim error occurred in the first place. She re-processed a claim without validating my query with me, and then chose to follow on an instruction without my consent. She tried deflecting her responsibility by saying it was the previous persons fault, I further informed her, that no instruction should be followed through without explicit consent from the customer. Call Reference 191120Q8N3HL

It is evident that when engaging with the agents telephonically, neither of them took the time to fully listen to my request, and acted upon actions without my consent.

Jacob Mooketsi, the team leader / supervisor contacted me after this, and we had quite a lengthy discussion. I would really like to encourage you to listen to this telephonic engagement. The Bonitas Claims process is significantly flawed that 3 people can make so many mistakes on just 1 claim. My further frustration is that I continuously find the Bonitas Claims process a gamble as I rely on the reimbur*****t of the funds to pay for my next Vendor service. Considering the time of the month, and the impact this error has had on me, I have been financially impacted. Jacob is completely disempowered, where not even he can speed up the claim process to reduce the impact this had on me.

I am also going to add into this complaint, that I have called your contact centre before and have complained about how unreliable the claims process is and continuously inconsistent. I have not had any response to the same queries submitted on your member portal either (submitted 19/10/2020 12:11pm). I already know that even this complaint, like every other email / query that goes to the *** email address, goes completely unanswered. With my survey reviews, I have previously indicated that your call centre agents are not well equipped to answer questions, and read off a call script which is not suitable for them, or it is just that their training is completely inadequate. It is also evident that skills like active listening is not something the Bonitas Contact Centre measure staff on, as already indicated in the 2 interactions above, for just querying 1 claim, is very evident. Further, to act upon requests between agents, and not obtain explicit consent from the consumer, has me questioning your process to effectively manage consumers money.

I am not oblivious to how the process occurs behind the scenes. It’s easy to distort a call, place a call on hold until the caller hangs up, sweep complaints under the carpet, complaints not addressed. I have made every attempt to speak to someone, email, lodge a complaint on the webpage, and nothing comes from it.

I am not impressed at how this claim was handled, and will be that person now to place this onto every complaint platform that is accessible to me to showcase just how ineffective the process is.

Thank you for the automated message to this complaint..