Pathetic Service

Really dismal service from Bonitas. Over the last 10 months the claim for an appliance was submitted and paid. From August onwards the Bonitas system was changed not allowing the ICD 10 codes to be visible. The service provider submitted the invoices directly clearly showing the ICD 10 codes. The August and September claims were rejected. After numerous follow-ups, calls logged and escalation, only the August claim was eventually approved and paid. I was told that the August claim was stagnant as someone in Bonitas did not do what they were supposed to.

The September claim was not paid. I logged another query. Only to go through the whole explanation again and being told that the IDC 10 codes are missing After checking it was verified that indeed the necessary information has been submitted multiple times. In my follow-up call, I was told that even though the claim clearly stated that this is not an in-hospital claim the claim went through as such and was obviously rejected since there was no pre-authorisation. I was told that I need to get the information from the hospital which is impossible since there was no hospitalisation. After a long explanation, the claim was escalated only to be rejected again due to the lack of the ICD 10 codes which have been submitted.

It is clear that the claims department DO NOT know what they are doing and incapable of reading the notes on the claim. After over 4 hours on the phone regarding this claim it is clear that there is sheer incompetence going on at Bonitas. It is easier to hit the reject button instead of actually reading and thinking.

Where is the compassion for patients? Why isn't a manager overseeing the repeated rejection of a claim? Why can't the claims department go back in history and see that the claims were paid and what was the Bonitas process followed?

There is no reason for these claims to be rejected. PAY IT.

Query numbers: 120923QTX***QWD2G8 120923QTX***QTBXKZ 051223QVSS7G 271023QX50Y4