PMB claims only paid at 60% rate

Good day

This is my 2nd Hellopeter complaint in less than 14 days because the only place where you guys action claims.

I submitted my PMB specialist refund claim 15/11/2018 and you rejected it saying you require a specialist referral letter, causing for complaint 1 on Hellopeter last week because you already authorized the specialist before so why would you ask a referral letter. Bonitas then created the specialist referral and processed the refund quietly not giving me any feedback, and when I called to asked what is going on I was told the claim has since been approved but now 1. Cover exhausted and 2. 60% of the PMB claim will be paid alone because it’s a non network / contracted doctor that rendered the service. Now it needs noting that I don’t have a network plan and secondly PMB enjoy unlimited cover subject to tariff, lastly only today i.e. 07/01/2019 received a list of “network doctors”.

How do you expect members to use your service providers if it takes you almost 3 years to communicate a process and secondly how do you justify applying network rules to a non-network member. You will not be allowed to deduct 40% when I don’t have a network plan that is *******.

My expectation is that you refund due i.e. 100% tariff for PMB claim and confirm your care plan authorized 2 specialist visits of which only 1 was claimed for so to tell me you will not even pay 1 100% is ********* conduct and contradicting your own prior authorizations.

Please resolve urgently,

Claim nr VRG ********** 151 Andri