INCORRECT CLAIMS PROCESSING

Hi There,

I am having the worst experience with Bonitas and specifically the processing of my claims.

On 29 January 2022 that a Care Plan was created for me (*** / 413196 / NMG000M. The plan is very clear on describing the service, extended description, tariff codes, the disciplines allowed and the no per year. It further states that I do not need need to do anything.

As a diabetic with high cholesterol and hypertension I went for my annual pathology in May, and to my shock BONITAS you have dismissed the CARE PLAN you created, and basically depleted my SAVINGS. Keeping in mind all the Tariff codes on my pathology account are as per the CARE PLAN and this is my first Pathology Test for the Year! All the below claims are processed incorrectly, and must be reversed and process correctly: Claims Processed and Paid to the Healthcare Professional (HCP)

Claims Detail Claims Payment Information* Amount paid from Reason Codes****

Beneficiary Treatment Date Tariff/Nappi Code**

Charged Amount Tariff Amount

Scheme Paid HCP Total Claim Shortfall

Member Owes Scheme Refund to Member

Payment Date Payment Reference Number

Savings Accum Account

Mauff A C & Partners (Practice number: ***) 00 Phillipina 09/05/***5.70 255.70 255.70 0.00 0.00 0.00 19/05/***75 255.70 0.00 505 00 Phillipina 09/05/***.90 59.90 59.90 0.00 0.00 0.00 19/05/***75 59.90 0.00 505 00 Phillipina 09/05/***.50 81.50 81.50 0.00 0.00 0.00 19/05/***75 81.50 0.00 505 00 Phillipina 09/05/***.90 61.90 61.90 0.00 0.00 0.00 19/05/***75 61.90 0.00 505 00 Phillipina 09/05/***.70 88.70 88.70 0.00 0.00 0.00 19/05/***75 88.70 0.00 505 00 Phillipina 09/05/***.10 92.10 92.10 0.00 0.00 0.00 19/05/***75 92.10 0.00 505 00 Phillipina 09/05/***.10 92.10 92.10 0.00 0.00 0.00 19/05/***75 92.10 0.00 505 00 Phillipina 09/05/***.10 92.10 92.10 0.00 0.00 0.00 19/05/***75 92.10 0.00 505 00 Phillipina 09/05/***.10 53.10 53.10 0.00 0.00 0.00 19/05/***75 53.10 0.00 505 00 Phillipina 09/05/***.90 81.90 81.90 0.00 0.00 0.00 19/05/***75 81.90 0.00 505 00 Phillipina 09/05/***.90 61.90 61.90 0.00 0.00 0.00 19/05/***75 61.90 0.00 505 00 Phillipina 09/05/***.40 91.40 91.40 0.00 0.00 0.00 19/05/***75 0.00 0.00 00 Phillipina 09/05/***7.80 117.80 117.80 0.00 0.00 0.00 19/05/***75 117.80 0.00 505 00 Phillipina 09/05/***5.80 135.80 135.80 0.00 0.00 0.00 19/05/***75 0.00 0.00 00 Phillipina 09/05/***5.80 235.80 235.80 0.00 0.00 0.00 19/05/***75 235.80 0.00 505 00 Phillipina 09/05/***5.30 335.30 335.30 0.00 0.00 0.00 19/05/***75 335.30 0.00 505 00 Phillipina 09/05/***.20 51.20 51.20 0.00 0.00 0.00 19/05/***75 51.20 0.00 505 00 Phillipina 09/05/***9.80 169.80 169.80 0.00 0.00 0.00 19/05/***75 169.80 0.00 505 00 Phillipina 09/05/***.30 38.30 38.30 0.00 0.00 0.00 19/05/***75 38.30 0.00 505 00 Phillipina 09/05/***7.80 117.80 117.80 0.00 0.00 0.00 19/05/***75 117.80 0.00 505 Total: 2314.10 2314.10 2314.10 0.00 0.00 0.00 2086.90 0.00