Refuse to pay their portion of PMB claim (non-DSP doctor)

<p>I have been trying for some time now to get clarification on why Bonitas has not paid a non-DSP doctor for a PMB claim as per the approved CMS rules but to no avail. I have been dealing with ***********, rude and unhelpful staff and management.</p> <p> </p> <p>In terms of the CMS Approved rules, Annexure D 7.5, it states clearly that the member is liable for 40% co-payment if a non-DSP is used for PMB claims. It does not state the Scheme is liable "up the Scheme rates" or the various different explanations that was given to me by Bonitas staff. Bonitas refuse to honour the remaining 60% they are liable for and depending on who you speak to - there is a different explanation each time.</p> <p> </p> <p>After querying further I was then told that Annexure D 7.1 applies - however they have not told me what is the definition of "cost"? My interpretation is the cost of the treatment as charged by the non-DSP doctor. They have completely ignored Annexure D 7.5 and refuse to settle the 60% in full.</p> <p> </p> <p>I asked to speak to a team coach and had the unfortunate experience of dealing with Fikile. Her approach is to try to dominate the customer, constantly talk over the customer, and refuse to listen or understand what the customer is saying. If a team coach has no tactful s****s in how to deal with customers, how can she coach or manage others? After going back and forth between the customer centre and Fikile I asked her for her direct email address so that I can communicate with her without any delays since the doctor has threathened legal action. She refused and her reasoning was she does not see the point and then accused me of talking over her. </p> <p> </p> <p>Not hiding her annoyance at my request to communicate directly with her, she then advised that she would get another colleague to deal with my complaint. I received a voicemail from Phumi who stated she would call me back later but did not. If this is how senior employees behave its no wonder the customer service at Bonitas is in the state it is. </p> <p> </p>