********* scheme rates

I was referred to an ENT specialist by my network GP by way of a letter on 14 Feb. I called Bonitas on 16 Feb and spoke to Junaid. I asked about the specialist as not a single network ENT specialist within a 50km radius of my home reflected on their app. I was told that they don't use network specialists, but the referring GP needs to call in and get referral auth. She did, and Bonitas authorized a specialist visit with a month validity.

My GP was reimbursed an amount of R481.50 -R120 co-payment for the visit.

The account for the specialist was R1200, which I paid and then submitted to Bonitas with the referral auth number. As per my plan, they pay for one specialist visit per year up to R1170 - R250 co-payment

Imagine my shock when they reimbursed an amount of R485 - R250 co-payment = R235

How can the refund amount for a specialist be less than that of a GP and their allocated rate be the same? Why then the need for all the hoops before visiting a specialist if Bonitas pays the minimum.

I called on 21 Feb and spoke to Nokothula (ref 210224Q2JL1S) and according to her the reason for the low refund is because the specialist is not contracted with Bonitas.

This is after I called first and was explicitly told by a consultant that I can go to any ENT AND after Bonitas gave an authorization for the visit knowing which specialist I intended to visit.

Firstly, it makes no sense that the scheme rate for a GP and a Specialist is the same. It's illogical.

Secondly, the fact that they use the excuse of a non-contracted specialist shows ********* behaviour.

100% tariff should be 100% whether contracted or not. If the specialist I visited charged 200% tariff, I would understand completely. But Bonitas saying they pay a lower scheme rate if a specialist is not contracted, yet they have no network specialists, is utterly dishonest on their part and I will be escalating this to CMS.

And this is after Junaid t