1 reviews | Active since Jan 2019
Major part of scheduled operation not covered, no feedback from fund to resolve issue
We've been with Bonitas for 18 months. My husband had a rotator cuff operation booked for Thurs, 4 June. We sent details to Bonitas 21 May and received four paged doc stating different procedures on the operation with just a note alongside each line "approved". There was also a line stating we had a co-payment of R5100. I mailed Bonitas for clarity, are all the amounts covered in full, will there only be a R5100 shortfall and what is it for? To date I have not received a response. The doctors rooms phoned the next day informing us that Bonitas does not pay for the anchors and *****s to attach the torn muscles and ligaments to the bone. Worst case scenario is a R41 000 - R44 000 out of our pocket payment. (How is the doctor supposed to attach the muscle, tendon & ligament if he can't use clasps and *****s?) Anyway, she also informed us that the anesthetist is never covered in full and there will be a co-payment as well, but unsure of the amount. We phoned the medical aid non-stop, not getting through, calls being dropped the second you select "hospital authorisations" and one time when we finally got through, there was an apparent system error and I was asked to phone back. When I asked if someone, including a manager, can please call me back my cellphone bill is through the roof, I was just told "no, phone back in two hours". Just to not get through again. So we were now forced to move the operation up, closest spot is in 6 weeks. So instead of my husband recovering for 6 weeks, he'll be in pain for 6 weeks, unable to perform his job properly (and he gets paid per job - it's physical work). And by the poor quality of service received so far I won't be surprised if this issue isn't resolved in 6 weeks. I want to know what we can do to resolve this? Is it true that our plan won't cover those clasps? Will it help to upgrade our plan? Must we move to another medical fund? I urgently need answers so we know what we're in for.
Bonitas team
Bonitas team
