Unfair Rejection of Claims and Poor Service

Good day,

I am extremely drained and angry with Bonitas regarding the ongoing handling of my claims.

On the first matter, I was given authorization to see a paediatric specialist. At the consultation, the specialist requested blood tests to assist with a diagnosis. I took my child for the tests.

A month later, I received an SMS and email from the pathology laboratory advising that Bonitas had rejected the claim as those tests are not covered.

I called Bonitas to enquire why, considering the referral came from a specialist for whom authorization had been granted. I was told the claim was rejected because the blood tests are excluded. However, in the Bonitas booklet it only states that "some blood tests are excluded" – it does not specify which tests are excluded. The consultant then advised that those tests are only covered if the patient is hospitalised.

I asked for a way forward, as the booklet was unclear. I was advised to obtain a motivation letter from the doctor who requested the tests and to email it to appeal the rejection, which I did on 23 July 2025. I received ticket numbers as the email was directed to the hospital and authorization departments. No feedback was ever provided – I was the one who had to keep calling Bonitas for an update. I have now had to make arrangements to pay for the blood tests myself, which I believe is completely unfair.

In June, I received another referral to a paediatric neurologist. At first, the authorization was rejected on the basis that the specialist is not within the Bonitas network. After checking your network, I found that you do not have the referred specialist listed. I was then granted an exception to see this specialist on the understanding that Bonitas would settle the account.

This week, I started receiving SMSs, calls and emails from the paediatric neurologist stating that Bonitas has decided not to settle the entire bill. As a paying member, what am I expected to do now? I have to make further arrangements to pay the outstanding balance.

I emailed Bonitas earlier this week and was told I would receive feedback within 3 working days. No feedback has been received to date. Bonitas consistently fails to provide feedback or respond to emails.

I request urgent intervention and a clear explanation in writing for both matters.