NON Payment of EMERGENCY CLAIMS

Bonitas Medical Aid, what is going on?

I had a Motor Vehicle Accident and was taken to the hospital's ER via an Netcare 911 Ambulance, and this is a Hospital that is part of the Bonita's network. Now my claims are not being paid. When I queried this I got told that no pre-authorization has been requested.

Pre-Authorisation for an Accident??

Please explain to me how the pre-authorisation must be done, when I am in an ambulance. Now I am sitting with bills that needs to be paid but I have medical aid, but the medical aid is rejecting most of the claims. Even the medication that I was given in the ER was declined.

I had to contact the case manager at the hospital and they advised me that when I patient comes with an ambulance to the ER they do not request authorization due to this being an emergency.

I had to contact the hospital and request them to ask for authorisation regarding my case. I was again informed that this is not standard practice. The Case Manager requested the authorization and now you have declined the request.

Please can you tell me why should I have medical aid. This is not how a member must be treated and now that I have managed to get the hospital to request a authorisation number then you decline the authorisation.

Please can you contact me regarding this matter!!

This is a total disgrace.

I have expected more from a Private medical aid.