Unacceptable CLAIM rejection: BONITAS Medical Fund

I have been a member of BONITAS Medical fund since early 2020. Never before did I have problems with Bonitas. Queries were addressed professionally and accurately. I understood the content of my plans and followed the rules as stipulated.

This time unfortunately I cannot agree with the outcome of a claim that was rejected by Bonitas. Reason being that it required specialist referral autohorization.

My wife has a back problem and to avoid back surgery she goes for a procedure in hospital which is called "Epidural injection/infiltration" of which I cannot explain because I'm not a medical doctor. What I do know is that some kind of long term cortisone is injected into the affected discs to release back pain etc.

This procedure was done on my wife in 2011 when we were at Discovery Medical fund and the second time on 17 November 2020 when I was a member of Bonitas already. Bonitas paid and we went on.

Every time we went back to the same orthopedic surgeon, Dr RW Swanepoel at NETCARE UNITAS hospital in Centurion. His knowledge of back problems is excellent every time he did a thorough medical examination. He was also the dr that prescribed VIMOVO to my wife for future back pain which she could use.

At the end quarter of 2025 my wife started to complain again of her back pain. We made an appointment at Dr Swanepoel again for 7 January 2026. He examined her again and recommended the same procedure as explained above as he wants to avoid a back surgery. I paid for the consultation with my debit card, R 1 300.00 and submitted it to Bonitas to claim it back.

I noticed on the Bonitas mobile app, while the claim was in process that I will not get back the whole amount of R 1 300.00, but just over R 1 000.00 which wasn't a problem for me.

However, when the claim was rejected with a remark code "2846" Specialist Referral authorization" I couldn't understand why. I phoned Bonitas Claims department requesting for an explanation as to why it was rejected with this code. I was told that it is one of Bonitas' Scheme Rules that you've got have a specialist referral letter for Bonitas to pay the claim. Without it nothing can be done. I tried to explain to the consultant that this is the THIRD time that my wife went for the SAME procedure, done by the SAME specialist. Why waste money to go to a GP, only to get a referral letter, to the SAME specialist? TOTAL WASTE OF MONEY.

I can understand when a specialist is visited for the FIRST time that a referral letter is required, but EVERY TIME to the SAME specialist?

The consultant said there is nothing that can be done as Scheme Rules cannot be changed.

It is for THIS reason that I decided to write a review on hellopeter. They are not even trying to be considerate to our position.

For me it makes no sense to waste money to pay for a GP consultation, just to ask for a specialist referral letter, whilst this was the SAME specialist and the outcome of his medical examination was again the SAME procedure.

And what's even more frustrating is the fact that my claim would have been paid out from my savings on my BONITAS Bonfit Select plan due to the fact that it was claimed in the first month of the new year.

TOTALLY frustrating and unacceptable. That money should be wasted like that and I thought I would get the payment I made back from BONITAS due to the fact that I have savings on my medical plan.