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Bonitas / NONPAYMENT OF CLAIMS

1 South Africa

I am a longstanding member of Bonitas medical scheme (for the past 16 years). I have problems of diabetes, hypertension, hyperlipidaemia, ischaemic heart disease and glaucoma.

I have been very unwell this year, necessitating several emergency visits and procedures, thus depleting my day to day benefits. I am a pensioner and cannot spare any further money for additional medical care.

Bonitas has subsequently sent me letters informing me of PMB allowances for the following pathology tests being available (Total Cholesterol / HDL / LDL / HbA1c). Yet, when I did go for these tests to Bouwer Labs on 28/09/2011, Bonitas rejected payment for these tests, stating that the savings have been depleted, despite the appropriate ICD-10 codes being used on the electronic submission of this account to Bonitas.

In terms of the Medical Schemes Act, I am entitled to these prescribed minimum benefits, and request that Bonitas agree to fund these expenses, as they have indicated.

Kind regards

Mrs A Naidoo
Bonitas member number [protected]

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