Worst Service & Admin - No Payment of Service providers

I received the worst service from Bonitas. It started with getting the authorization for the procedure. The authorizations department was uncertain regarding the hospital and doctor being on their network. It was so embarrassing that one consultant mentioned Netcare Blaauwberg Hospital is not on their network yet it appeared on the Bonitas application and website as a network hospital. They even mentioned the doctor was not on the network yet another consultant on a previous call, said the doctor was on the network when they were given the doctor's practice number. This left me feeling uneasy regarding Bonita's administration procedures.

You find situations where the doctor is on the network yet the hospital they are operating in is not on the network. I think it is rather unwise to have doctors on the network and not ask them to include the hospital they operate into the network. Bonitas does not have UCT Private Hospital on their network. Yet it has doctors working at Netcare UCT Private hospital on their network. It just does not make sense and makes unnecessary admin for patients.

I had to do a run around to find a doctor and hospital on their network. The consultants at Bonitas also did not know. Many were unhelpful and unprofessional. When calling in, the lines got cut and many clerks used load shedding as an excuse for the lines getting cut. They do not return calls yet they are the ones having telephony issues and have your details on the system as you are engaging with them when their lines cut.

I eventually managed to undergo the procedure. The was a point where I wanted to rather give up because of how hard Bonitas makes it for their clients. I had to pay a co-payment of R 1 590 before the procedure which I paid. Bonitas eventually gave the authorization to go to the hospital and doctor for the set procedure.

Now the procedure is done and service providers are submitting the claims . Bonitas is trying every reason not to pay. They firstly do not want to pay the anaesthetic Doctor. They amount the doctor charged is R 3 908, they only want to pay R 1 367.16. The amount they want to pay as per their scheme rates is not even half of the amount charged by the anaesthetic.

When I went to see a doctor who happens to be on their network I paid cash for the consultation because the doctor apparently battles to get their money from Bonitas. They seem to not want to pay. I am now claiming back the consultation fee for seeing the specialist from Bonitas. Please take into account the referral letter was provided to Bonitas that was received from the GP. The consultation was R 1 100 to see the specialist. I paid for this cash. Bonitas only wants to reimburse me R 455.40 as per their scheme rates. Now how on earth can you want to pay R 455.40 for a specialist consultation. Bonitas is trying by all means not to pay their service providers and keeps using scheme rates as an excuse. You cannot even see a general practitioner for R 455.40

The cherry on top is while I was in hospital I was given compression socks before the procedure to prevent blood clots while I underwent the operation. Apparently I was supposed to get authorization. According to Bonitas remark codes 379/ 8416 The service requires appliance authorization and its an exclusion from the scheme. I'm actually laughing at this joke. So according to Bonitas I should have received authorization for compression socks that are mandatory for patience going for operations. The socks are R 370 that Bonitas does not want to pay the service provider.

What makes this a joke is I received authorization for the procedure before going to hospital. I'm just waiting on them to tell me they will not pay the surgeon for the procedure. Bonitas makes it difficult for their patience. This was my first operation and it truly was the worst experience. Instead of the medical aid offering peace of mind it created anxiety, stress and just added to the problems.

I have raised queries as they come and have received no satisfactory response. I will also be taking this matter to the Ombudsman for further deliberation.

My thoughts are if I were to be in a seriously difficult medical position. I would see flames with Bonitas!

Query: 300923QVKZ76 Query: 300923QVKZ7H

Bonitas you need to do better!