No feedback, false hope & appalling client services

To whom it may concern, Bonitas, Mr Lee Callakoppen, Bonitas medical scheme board members

I am writing this email to express my experience, feelings and unsatisfactory client services that I have received from bonitas medical scheme since the 3rd of January 2023. As well as lodging a formal complaint with bonitas & requesting this matter to be escalated to the council of medical schemes.

Where do I begin?

I have been a loyal member of Bonitas medical scheme for the past two years, this year going into the third, I have never in the years prior to date have had to use my medical aid for anything serious, therefore, never really had the opportunity to deal with bonitas telephonically, or via email, up until recently.

On the 6th of December 2022, I had to undergo a below the knee amputation due to severe osteomyelitis in the right leg. Which to any human being is quite a traumatic experience, I was hospitalized for four days and then released without any complications.

On the 3rd of January 2023, myself and my prosthetist decided to get the ball rolling and start the process & funds seeking from Bonitas.

My prosthetist evaluated me & filled in all the necessary paperwork in order to complete a thorough quotation, a letter of motivation, photos and along with the valuation stipulating that according to my active lifestyle and work requirements, that I am a K4 level amputee, therefore requiring the most appropriate & comfortable prosthetic leg possible.

All the necessary documentation, quotes, codes, photos etc. was sent to Bonitas on the 3rd of January 2023, after which a few emails were exchanged between myself, my prosthetist & Bonitas, eventually bonitas said they will only pay the pmb limit (R51 400 on standard plan), however because I am evaluated as a K4 level amputee, this requires a more advanced type of prosthetic device thus the reason for our quotation being in the amount of R143 000 tax Inc. We wrote an email back to bonitas pleading for the consideration of extra funding due to the fact of the above mentioned.

Bonitas then asked us in order for the extra funding to be considered we the have to provide 3 seperate quotes from different suppliers with clinical photos of the components which would then make up the prosthetic device. We had done that straight away and did what was asked of us, after which we received an email back stating they will then only require our quotation but with discount, my prosthetist agreed and gave a R13 000 discount and we resent the amended quote as requested from bonitas. Please keep in consideration, besides the R13 000 discount, all services rendered by my prothetis so far, was not billed to bonitas, nor was the specialized stump shrinkers that my prosthetist supp**** me with (a total of 2), which is to the value of R8000 each, he also did not bill bonitas for this.

After a lengthy battle back and forth asking for some indication on the outcome it was finally decided not to grant extra funding.

Please also bare in mind all of this has now occurred over the course of a month and a half since the 3rd of January 2023.

Why would bonitas get our hopes up, asking for quotations and discounts if it was never in their intention to grant us extra funding? This is absolutely shocking and from my personal point of view a sick mind playing game with someone who has just undergone a traumatic amputation & who's lifestyle has changed drastically.

Since the 3rd of January 2023, I have spent over R1200 of my own money calling bonitas for indications on outcomes, asking to speak to relevant people, most of which had no clue what to do, on 4 seperate occasions I was transferred to a hospital from bonitas for pre authorisation, what does 'n prosthetic leg have to do with pre authorisation from a hospital? Every single time I spoke to someone pleading for answers and seeking info on my case I was promised a call back but instead over the past month and a half all I have received were emails stating they were attending to my case without any relevant info on an outcome etc. I've asked to speak to supervisors, team leaders, managers & no one is ever available to talk to me further.

I had then contacted the Cms which they advised me to contact Mr Lee Callakoppen directly on his office nr, I did this on many occasions over the course of a week and I always get told he is never available.

I was supposed to start with the fitting process about 3 weeks ago already, because of Bonitas incompetence, absurdly poor client services and delay in an outcome on funding including the sick mind games of hope, i am losing unnecessary muscle mass in the residual limb as well as my tendons stiffening due to no use of the leg, physio and self physiotherapy only help to an extent, and this is all detrimental to my health and well-being. I cannot believe that bonitas would pull such a stunt with clients.

I am honestly considering taking this matter to the highest possible authority, should I consider changing medical aids to one that can actually accommodate? We as clients spend thousands of Rands a year just to be declined, toyed around with and mind games played on us in the hopes of authorisation and funding, why waste our time and request discounts and additional quotations in the likelihood of giving me hope if it was never even to be considered? To add to this, the crutches I was provided for in hospital broke due to poor manufacturing, requiring me to purchase new crutches and claim back from the medical aid, of which you refuse to pay for something so basic for an amputee because it is excluded from the standard plan, I pay thousands a year, but to my surprise not even be able to claim the most basic tools funding me back into my account, Bonitas takes money but doesn't give back when appropriate, this is just plain *******.

This has caused me severe depression & anxiety on top of the problems I am facing as a new amputee, this experience has caused me such frustration on top of what I already have to deal with as a recent amputee. I am appalled & absolutely sick to my stomach by this experience that bonitas can allow such unprofessionalism, and ***ardice acts of giving clients hope in emails if it was never their intention to, just in the hope of keeping us quite, so give us a little hope.

There is still so much to this experience I'dike to add, and all of this in the period from 3rd January 2023 to date.

I will end this by asking Mr Lee Callakoppen or someone in the same capacity who is willing to deal with an extremely unsatisfied client to give me a call directly, which I doubt will even get further than a call center agent calling to apologize for the experience which is always the same old story.

Please take note that I will once back at my employer, start a petition with all unsatisfied clients to urge our employer to discontinue using the services of bonitas medical scheme, I will also seek legal assistance in pursuing a nation wide petition with all unsatisfied & poorly treated amputees by Bonitas with regards to false hope etc.

Bonitas, on the last note I would like to add, you as a medical scheme have given me severe depression, anxiety, frustration but most of all false hope to an amputee going through a really difficult period in his life. WELL DONE!!!