RP
Ronald P

1 reviews | Active since May 2011

14 May 2019, 14:26

Scheming medical sheme

I recently went to my GP where I discussed a medical procedure and he referred me to a specialist. This is my first time ever in over 6 years since joining the medical aid that I have been referred to a specialist and was unaware that I have to obtain "authorisation" before I can consult with the specialist. Long story short the specialist agreed to do the procedure and all necessary hospital authorizations and approvals were obtained. The procedure was done and upon my discharge from hospital I receive a statement from the specialist advising that bonitas refused to pay the initial consultation fee as I did not have authorisation.

Another claim they refused to pay - I recently went for blood tests at Cuyler Hospital in Uitenhage on instruction from my GP. It was a quick in-and-out and all blood samples were taken in under 5 minutes. 2 weeks later I receive a statement from the pathologist where bonitas rejected to pay part of the claim - reason "due to the tests was not done in-hospital". Well the tests were all done inside the hospital. My understanding is that I first had to get hospital authorisation, be admitted to hospital and then do the test while I'm a patient in the hospital. Where is the logic in that?

0
Replies (4)
Bonitas Medical Fund
Bonitas Medical Fund's reply15 May 2019, 09:51
Official
Hello Ron5000,

Thank you for submitting your details to us through Hello Peter. 

This is to confirm that we have received your information and that we are currently investigating this matter. 

Our representative will be in touch with you shortly to discuss this matter and ensure that it is speedily resolved. 

Kind regards, 
                          Bonitas Team  
RP
Ronald P's update16 May 2019, 11:27
Reviewer Update
Okay thanks. I'm still waiting for your representative to call me?
Bonitas Medical Fund
Bonitas Medical Fund's reply17 May 2019, 12:49
Official
Hello Ron5000,
As per our telephonic conversation your query is still being investigated and we will keep you updated until the matter has been resolved.
We appreciate your patience while we are resolving this query for you.
Regards,
Bonitas Team
Bonitas Medical Fund
Bonitas Medical Fund's reply21 May 2019, 13:55
Official
Hello Ron5000,

Thank you for submitting a comment to us through Hellopeter. 

According to the telephonic conversation with our representative, we hereby confirm that your concern has been addressed and this matter has now been resolved. 

As Bonitas we strive to give the best customer service to our clients and appreciate it when you bring your concerns to our attention when we have failed to deliver this service. 

We apologise for any inconvenience caused to you. 

Thanks and regards, 
              Bonitas Team