UNSATISFIED BONITAS STANDARD MEMBER

Good day

My husband has been a member of Bonitas Standard medical aid since August 2011.

On 19 November 2018 he was in a motorcycle accident which he did not cause. A bakkie skipped an intersection and collided with my husband.

He was transported the the Alberton Union Hospital on the same day due to his injuries. After CT scans and an MRI was done, the doctors concluded that he has 3 compression fractures on his vertebral bodies. The doctor ordered a frame to be specially made for him before he can be able to stand up, walk and be discharged from the ICU.

On the 20th of November 2018 I was contacted by the Orthopaedics who confirmed that the medical aid rejected the claim for the frame and that I needed to pay R13 292.00 in cash for the frame to be made. Once again, my husband needed the frame to be able to stand up, walk and be discharged from the ICU, and I paid the money.

I contacted the medical aid who said that the frame is covered by the appliance cover on our medical aid and that there is a certain process to be followed. They need a motivation letter from a doctor together with 2 quotations before the claim will be considered. This process takes 30 days to finalise.

Now, as you can note from the above, the compression fractures was not caused by a long term back problem, but due to a sudden unforeseen motorcycle accident.

On the 27th of November 2018 I sent an e-mail with the MRI results together with the account which I have already paid, to Bonitas to claim back the said funds. The only thing I get back is an automated reply from their no-reply e-mail address which confirms that my request was sent to the Special Cases Department. Not once have I received an e-mail from the Special Cases Department confirming that they have indeed received my claim and the specific procedure that needs to be followed.

I feel that my husband was in need of urgent medical care, and we received no co-operation from the Medical Aid with regards to the much needed frame.

I need to know how the medical aid can request for this process to take place before approving the frame whilst my husband was in ICU. I also need clarification on the status of my claim and when we can expect payment from the Medical Aid.