PMB BENEFITS - pathetic service - Chronic conditions not correctly covered!!!

PMB benefits is a nightmare - in 2015; 2019 my husband unfortunately suffered a heart-attack which led to heart operation with the insertion of stents. Treatment has been done by a Network Cardiologist that Bonitas Medical Aid suggested. - my husband could not go for his annual check up in 2020 due to COVID-19 and having Coronary Heart Disease and Chronic Asthma - he kept himself isolated away from hospitals and doctors and public environments but at the beginning of the year his GP advised he had to go see the Cardiologist for his check up and to obtain chronic prescription renewal. After confirming with Bonitas and obtaining an authorization number for treatment at both Cardiologist and Pulmonologist - Bonitas claims department depleted my husband's day to day savings processesing both the Cardiologist ; Pulmonologist and Pathologist account towards daily savings - this was in February 2021- May 2021 I am still fighting to have all claims reversed off the day to day benefits as both Coronary Heart Disease and Chronic Asthma is Chronic and all treatments have to come off PMB benefits; according to Bonitas only certain ICD-10 codes go off PMB benefits and the balance of icd-10 codes we have to pay for either cash or off day to day benefits; if the specialist sends for blood test - even though it is part of treatment for your chronic condition - you have to pay for it yourself ; PMB benefits don't cover it. For a full year Bonitas refuse to pay for my husband's prevention inhaler for asthma - only after going to the SA Asthma Federation did they now start paying for his inhalers; they only paid for the Bronchilator inhaler but refused to pay for the relief and prevention inhaler - for a year we had to pay for it ; which cost us a fortune. Treatment for Asthma is Chronic; but they refuse to pay for it.

Blood pressure tablets & Cholesterol medication - since 2015 my husband has been on blood pressure tablets as he has high blood pressure and high genetic cholesterol ; we over the years have changed it to their formula to prevent co-payments now suddenly after 5 years at the beginning of 2021 ALL blood pressure medication and Cholesterol tablets - doesn't matter what medication you take you have to pay co-payments of over R150.00 plus. PMB benefits do not cover all Chronic medication - even though they state that treatment for chronic conditions are covered ; they are not, you are forced to pay for it and fight for 6 months to get incorrect claims rectified.

My main frustration is that they inconveniently depleted my husband's day to day benefits and it is taking me more than 2 months to get it rectified - in the mean time I had to pay doctors bills and pay for medication as there is no funds due to their incorrect claim allocation.

Every time I send the reference number through a new one is allocated and I have to wait another 10 - 12 days to get the issue resolved.

Don't be fooled CHRONIC conditions as per their list is not covered by PMB Benefits!!!!! - Consultants are clueless even when you provide authorization codes; will only assist with what their manual tells them to assist with. You are unable to get through to the necessary departments as they do not take phone calls and following up with them results in receiving new reference numbers and waiting......waiting and waiting - service is pathetic!!!