TN
Tebogo N

1 reviews | Active since Jan 2018

09 Jan 2018, 12:15

Non payment of claim

As a paying member of the medical aid, I expected to be assisted professionally when I was sick. I needed an iron injection urgently last year. I called Bonitas to get authorization and I got a letter on the 06 September 2017 declining the authorization. The people from the doctors called Bonitas on my behalf and we subsequently got the authorization letter on the 10 September 2017 but the Admission date was stated as 05 September (a date that had already passed). Based on the authorization, the injection was done on the 15 September 2017. Of the R4867.25 that the treatment cost me, only R484.89 was paid by Bonitas. From October 2017, we have been following up with the medical aid until today (9 January 2018) the claim is still not paid. The first reason I got was that the letter stated the admission date to be 05 September and the actual date of the treatment was 15 September, Bonitas requested the doctor to change the treatment to 05 September, which the doctors refused to. Eventually the date was changed by Bonitas to the correct treatment date. On 01 November 2017 I got a closure of a query letter, apologizing for the delay and that the claim will be sent for processing. I was surprised today to get a call from the doctor saying the account is still not settled, I called Bonitas again today, only to find out that the claim was sent wrongly to the hospital section when it was supposed to be sent to the doctors section. Why cant the employees there know where to send a claim? If a claim has been outstanding for this long, cant they prioritize it and process it quicker? Is 3-4 months acceptable time to close a query? I find this to be sooo unprofessional of Bonitas and the service very pathetic. I am not a person very prone to sickness, I have been with Bonitas for years, when I need help, why cant I be assisted, or somebody explain clearly what is the matter?

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Replies (1)
Bonitas Medical Fund
Bonitas Medical Fund's reply09 Jan 2018, 14:31
Official

Hello tebzatea,

Thank you for submitting a comment to us through Hello Peter.

Kindly reply privately with your membership number and contact details in order for us to assist with your query.

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Kind regards,

Bonitas Team