MM
Miriam M

1 reviews | Active since Aug 2012

10 Apr 2024, 17:13

Punished at my most vulnerable time

I am so frustrated with Bonitad. I havr tried to be patient but they havr been pushing me from pillar to post. On 4 February I was admitted Fourways hospital for a hip repacrment surgery. Before that i requested for authorazation and i was told that there was a copayment of R35250 for using a service provider who is no contracted. When i inquired i wad told that it was for using a Dr who was not on the network. I was also told that Bonitas had a hip trearment plan which i was supposed to use. Now background...I have had the hip issue since 2018 and been to Drs and MRI scans claiming from the samr medical aid. I even had a hip op in 2019 and been to drs even after. All this time i was not being told about the treatment programme. When they told me about in February i was in deep pain and didnt mind paying if the Dr charges more than scheme rate. Also going to the Bonitas hip programme meant reversing efforts and wasting more money as the problem had already been diagnised...but the explanation i got about the programme is that it's meant to protect us from getting unnecessary hip ops....my situation was bad and the Dr wrote a motivation with results and everything. Back to the matter, two weeks into rwcovery i get a letter from the Dr's accounta deparrment showing that bonitas only paid scheme rate and i was surprised as i thought the R35250 was going to the Dr. Turns out the amount went towards my hospital account, just as additional punishment for using my prefered to...so i paid a shortfall and a copayment. My plan's benefit on hospital cover is unlimited. Fourways is one of the hospital i can be treated at under my plan without copayment. Why the the copayment? Bonitas tried to force it into the hospitl account...my benefits show that I have a benefit of R54700 for the prothetic hip, the exact amount charged by the service provider but to qualify the copayment bonitas paid R41000 and said it was scheme rate. What scheme rate when my Benefit is clear...I was eveb charged for being in higjcare among others. I have followed proper dispute channels but i am being frustrated. Bonitas said the hospital must contact their Case managers to rwmove the charge. The hospital has logged the matter twice and Bonitas is not responding. Imagine suffering and getting into debt because the medical aid refuses to check cases individually. I had no issues paying the shortfall for a Dr not on the network but the hospital is. Their scheme rules in this case also dont apply as i have explained when i get to know about their programme. What purpise does this penalty save? What lesson was I being taught when i was having such a major op. I cant wait for the year to end so I can move. I really trusted them but this is really frustrating me.

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Replies (9)
Bonitas Medical Fund
Bonitas Medical Fund's reply10 Apr 2024, 17:38
Official
Hello Miriam Thank you for notifying us of your complaint. We are so sorry to hear about this, we are glad that you brought this to our attention to resolve. Our Office hours are 08:00 - 16:00 Monday – Friday. Closed on weekends and public holidays
     Your enquiry will be attended during office hours. Kind Regards
  Bonitas Team 
MM
Miriam M's update10 Apr 2024, 18:45
Reviewer Update
I hope this time it will be resolved. I have gotten so many of these responses.
Bonitas Medical Fund
Bonitas Medical Fund's reply11 Apr 2024, 10:03
Official
 Hello Miriam 

Thank you for notifying us of your complaint, we are sorry to hear about this, we are glad that you have brought this to our attention. 

Kindly provide your membership number or ID number of the principal member privately (to protect your personal information not to be visible on this public forum) to investigate your enquiry. 
          
Kind regards
     
Bonitas Team 
Bonitas Medical Fund
Bonitas Medical Fund's reply11 Apr 2024, 13:11
Official
  Hello Miriam 

Thank you for notifying us of your complaint. We are so sorry to hear about this, we are glad that you brought this to our attention to resolve. 
 
We will investigate this matter. 
 
We appreciate your patience while we are resolving this query for you. 
 
 Kind regards
     
Bonitas Team 
MM
Miriam M's update11 Apr 2024, 14:01
Reviewer Update
You responded to the wrong person on my thread but i hope my casd is also being attended to
Bonitas Medical Fund
Bonitas Medical Fund's reply11 Apr 2024, 23:26
Official
Hello Miriam 

Thank you for notifying us of your complaint. We are so sorry to hear about this, we are glad that you brought this to our attention to resolve. 
 
We will investigate this matter. 
 
We appreciate your patience while we are resolving this query for you. 
 
 Kind regards
     
Bonitas Team 
MM
Miriam M's update15 Apr 2024, 11:59
Reviewer Update
I am still waiting for feedback...is this going to remain hanginh like my other effort to get help?
Bonitas Medical Fund
Bonitas Medical Fund's reply16 Apr 2024, 10:21
Official
Hello Miriam Thank you for submitting a comment to us through Hellopeter. According to the email communication, we hereby confirm that your concern has been addressed and this matter has been resolved. As Bonitas we strive to give the best customer service to our clients and appreciate it when you bring your concern to our attention when we have failed to deliver this service. We apologise for any inconvenience caused to you. Regards Bonitas Team
MM
Miriam M's update16 Apr 2024, 10:29
Reviewer Update
This is far from being resolved. You just treated this as if it's a first time query and ignored the fact that I started that it was with your case managers who are supposed to give me feedback on a refund but act all confused. I am taking this to the CMS.