DS
Dirk S

1 reviews | Active since Jan 2013

18 Jul 2024, 10:15

Unpaid claims without cause

During end of 2023 I started suffering debilitating pain with mobility, and struggled to walk and do simple daily tasks. I was admitted to hospital, and a facet block was done. Approximately three weeks later I was again admitted for the same, and a rhizotomy was done. The neurosurgeon then advised that I will eventually need to go for a spinal fusion. I app**** for upgrade on my medical aid, to include the internal prothesis as well as surgery. The neurosurgeon indicated that he would only do it after I recovered from emergency surgery after a burst stomach ulcer which caused me to be in ICU for 6 days. I also suffer from ischaemic heart disease after suffering 5 heart attacks in 2022 resulting in the placement of a stent. The neurosurgeon advised that I need to recover and build up strength. My medical aid approved my upgrade as from 01nJanuary 2024, and I receievd a mail to that affect. On about 28 january I was again admitted to hospital fro severe pain, and the neurosurgeon decided that I require surgery. I waited at reception until all authorisations were received and was then admitted. I think the procedure was done on 2 February, again after the neuro-surgeon rooms advised that they have received authorisation. Approximately 2 months later I received e mails indicating that the hospital as well as the neuro-surgeon and physician were not paid, as the authorisation was reversed. On contacting the hospital and the neurosurgeon I was advised that they indeed received authorisations. I then contacted Bonitas and was informed that they app**** for the authorisation against my old membership number prior to the upgrade.

I was treated and operated whilst under the full impression that all necessary authorisations were received. That was also confirmed by the hospital as well as the neurosurgeons rooms.

I do NOT have the funds to foot that bill, as I have been terminated from my former employer due to my health, and I am reliant on family to assist in paying my rent, medical aid, medication groceries etc.

I believe that Bonitas acted *********ly. I have lodged complaints against them, and the hospital also escalated thye matter of both the hospital bill as well as the neuro surgeon to them, to no avail, and II have also not received any reply. Now I received a further account from the physician who attended to me after the procedure, indicating that it was not paid as the ischeamic heart condition as well as hypertension "does not fall in the treatment plan", however, I have been on chronic medication and was registered as a PMB since June 2022.

Am I actually covered for anything still?

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Replies (1)
Bonitas Medical Fund
Bonitas Medical Fund's reply18 Jul 2024, 10:51
Official
Hello Dirk

Thank you for notifying us of your complaint. We are so sorry to hear about this, we are glad that you brought this to our attention to resolve. 
 
We will investigate this matter. 
 
We appreciate your patience while we are resolving this query for you. 
 
Kind Regards 

Bonitas Team