Misleading Clients

Dear Bonitas Team,

I am writing to formally request a detailed explanation and raise a concern regarding an unexpected co-payment app**** to my claim for treatment received at Zwavelstream Clinic on 09 July 2025 (Claim number: ***).

Prior to my admission, I contacted Bonitas for pre-authorization, and I was clearly advised that no co-payment would apply. Based on this confirmation, I proceeded with my treatment, fully trusting that the medical aid would cover the costs as discussed.

However, upon review of the claim details, I noticed the following:

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Claim Breakdown:

Claim 1

Amount charged: R24,620.40

Scheme rate: R24,620.40

Paid to provider: R17,234.28

Co-payment incurred: R7,386.12

Claim 2

Amount charged: R8,169.90

Scheme rate: R8,169.90

Paid to provider: R5,718.93

Co-payment incurred: R2,450.97

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Total Out-of-Pocket Cost: R9,837.09

This constitutes approximately 30% co-payment, which was never disclosed to me prior to treatment.

I am extremely concerned and feel blindsided by this outcome, especially after being explicitly told during the pre-auth process that no payment would be required from my side. This has caused financial distress and a breach of trust in the support I expected during a time of medical vulnerability.

I respectfully request the following:

1. A full written explanation of why a 30% co-payment was app**** despite pre-authorization stating otherwise.

2. Confirmation of the scheme rules or plan limitations that led to this partial payment.

3. If this was an error, I request a reassessment and refund of the co-payment amount already made.

4. If not an error, kindly explain why inaccurate or misleading information was provided during the pre-auth call.