Bonitas blames Medscheme for medical scheme backlog

RedViking

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www.businessday.co.za

Bonitas blames Medscheme for medical scheme backlog

Members complain over unresolved queries and delays after switch from Medscheme
www.businessday.co.za www.businessday.co.za


Members of Bonitas medical scheme are up in arms over unresolved
queries and hospital authorisations after it changed administrators
earlier this week.

Bonitas is South Africa's second-largest open scheme, with 750,000
beneficiaries, making the switch in administration companies the
biggest the industry has seen yet.

Bonitas has blamed its members' woes on its previous administrator,
Medscheme, which in turn has pointed the finger at the new service
providers, Momentum Health and Private Health Administrators
(PHA). Medscheme and Bonitas are already mired in conflict, as
Medscheme took Bonitas to court last year over its planned change in
administrators, alleging tender irregularities.

Earlier this week dozens of Bonitas members took to social media to air
their complaints, many of which centred on distressing delays and a
lack of response to authorisation requests after the new service
providers took over on June 1. Medical schemes require members to
obtain prior approval for some planned procedures and hospital
admissions, as well as costly tests and treatment.
 
We've never had issues with bonitos. MIL is in hospital and need to be urgently transferred to a care facility! But BONITAS is not answering any calls or emails and none of the hospital can't get authorization to do the transfer. It is already 5 days due and the longer she is in the that hospital the greater her chance of not getting better. I was about to start a thread and then saw the news articles!

So not only are we dealing with incompetent nursing staff and specialists and a superbug, and mom not getting her chronic medication, we now have to deal with this.

I AM FREAKING Furious!
 

Bonitas members caught in service disruption after administration switch – Moonstone Information Refinery

www.moonstone.co.za www.moonstone.co.za

www.ewn.co.za

Bonitas members face challenges as Momentum Health takes over administration

Some members have reported difficulties accessing online platforms, updating personal information and obtaining confirmation of benefits or authorisations during the transition.
www.ewn.co.za

 
RedViking said:
We've never had issues with bonitos. MIL is in hospital and need to be urgently transferred to a care facility! But BONITAS is not answering any calls or emails and none of the hospital can't get authorization to do the transfer. It is already 5 days due and the longer she is in the that hospital the greater her chance of not getting better. I was about to start a thread and then saw the news articles!

So not only are we dealing with incompetent nursing staff and specialists and a superbug, and mom not getting her chronic medication, we now have to deal with this.

I AM FREAKING Furious!
Click to expand...

I heard about this on the radio the other day. What a shambles.
 
RedViking said:
We've never had issues with bonitos. MIL is in hospital and need to be urgently transferred to a care facility! But BONITAS is not answering any calls or emails and none of the hospital can't get authorization to do the transfer. It is already 5 days due and the longer she is in the that hospital the greater her chance of not getting better. I was about to start a thread and then saw the news articles!

So not only are we dealing with incompetent nursing staff and specialists and a superbug, and mom not getting her chronic medication, we now have to deal with this.

I AM FREAKING Furious!
Click to expand...
Terrifying.

One day its a great scheme and next moment everything falls apart. And its not like you can quickly move to a new scheme and continue off.

Hope you can get it sorted out.
 
t0dd said:
Terrifying.

One day its a great scheme and next moment everything falls apart. And its not like you can quickly move to a new scheme and continue off.

Hope you can get it sorted out.
Click to expand...
On top of that we have to deal with the absolute disaster of a hospital, medical staff and arrogant specialists! This country really has gone to the dogs.
 
RedViking said:

www.businessday.co.za

Bonitas blames Medscheme for medical scheme backlog

Members complain over unresolved queries and delays after switch from Medscheme
www.businessday.co.za www.businessday.co.za


Members of Bonitas medical scheme are up in arms over unresolved
queries and hospital authorisations after it changed administrators
earlier this week.

Bonitas is South Africa's second-largest open scheme, with 750,000
beneficiaries, making the switch in administration companies the
biggest the industry has seen yet.

Bonitas has blamed its members' woes on its previous administrator,
Medscheme, which in turn has pointed the finger at the new service
providers, Momentum Health and Private Health Administrators
(PHA). Medscheme and Bonitas are already mired in conflict, as
Medscheme took Bonitas to court last year over its planned change in
administrators, alleging tender irregularities.

Earlier this week dozens of Bonitas members took to social media to air
their complaints, many of which centred on distressing delays and a
lack of response to authorisation requests after the new service
providers took over on June 1. Medical schemes require members to
obtain prior approval for some planned procedures and hospital
admissions, as well as costly tests and treatment.
Click to expand...
wow... changing medical aids terrifies me (I was forced to do it once).

I had no idea your medical aid could change medical aid.... what a complete f-ckup
 
I work in the industry that switches the claims for Schemes and Doctors.
This change has made Momentum Health the 2nd largest Medical Scheme in the country behind Discovery Health, in terms of patients / members

The go-live was supposed ot be Monday June 1, we where ready and waiting for switch-over.
I have been doing this for 19 Years, never such an issue.

On SUNDAY May 31 we receive a message "The scheme has advised that we are required to await formal confirmation and approval from them before enabling Real-Time claims processing. As such, the RT functionality will remain on hold until we receive the official go-ahead from the scheme."
Click to expand...

Then on D-Day June 1:
Bonitas Medical Fund - Claims on Hold Communication to Healthcare Providers:

Bonitas claims on hold for the period 01 June 2026 to 05 June 2026

As you are aware, Momentum Health (‘Momentum’) has been appointed as the administrator for Bonitas with effect
from 1 June 2026. As a result of the transition, Momentum will be conducting a post-implementation review and audit
of claims received from the previous administrator Medscheme. This exercise is necessary to ensure that there is
minimal disruption in the application of tariffs, rates and benefits. This will also ensure the current benefit design and
assessing rules are applied consistently (as far as is practically possible) post the transition.

Even though this transition represents the largest transfer of a medical scheme in the South African medical aid industry,
Bonitas’ primary objective is to ensure that there is continuity of and uninterrupted access to care for Bonitas members.
Where possible, Bonitas also wants to ensure that re-imbursement rates are also maintained post the transition.

To achieve the above objectives, claims for Bonitas members will be placed on hold from 1 -5 June 2026. Switching
channels will therefore remain closed until the exercise has been concluded. Claims placed on hold will then be released
and processed for inclusion in the Fund’s claims run of 15 June 2026.

Real-time pharmacy claims will not be subject to the above embargo and will be processed as per normal
(for settlement in the claims run of 15 June 2026).

We encourage switches submitting non-pharmacy realtime claims to hold off on submitting same till after 5 June 2026.
Momentum commits to communicating with hubs and switches when the requisite channels have been activated for
submission.

If you have any queries, we encourage you to reach out to our Provider Call Centre at 0860 002 108.

Bonitas thanks you for your understanding and continued support and commits to keeping you apprised of developments
during this transition.

Kind regards
Bonitas Medical Fund
Click to expand...


And yes, for those asking - Medical Schemes change hands (Administrators) sometimes - and generally it is a smooth transition.
The opposite happened not too long ago where Sisonke Left Momentum and Went to MedScheme (Previous Administrators of Bonitas)
 
Anthro said:
I work in the industry that switches the claims for Schemes and Doctors.
This change has made Momentum Health the 2nd largest Medical Scheme in the country behind Discovery Health, in terms of Patiens / members

The go-live was supposed ot be Monday June 1, we where ready and waiting for switch-over.
I have been doing this for 19 Years, never such an issue.

On SUNDAY May 31 we receive a message "The scheme has advised that we are required to await formal confirmation and approval from them before enabling Real-Time claims processing. As such, the RT functionality will remain on hold until we receive the official go-ahead from the scheme."

Then on D-Day June 1:



And yes, for those asking - Medical Schemes change hands (Administrators) sometimes - and generally it is a smooth transition.
The opposite happened not too long ago where Sisonke Left Momentum and Went to MedScheme (Previous Administrators of Bonitas)
Click to expand...
Thanks for sharing. What a mess.
 
What a stuff up. My company recently moved most of our members into Bonitas. We could also choose discovery so I went with them fortunately but this is a proper mess. About as bad as the time KFC UK changed chicken suppliers and had to close most of their stores when they could not not get any stock anywhere. Big changes can mean big disruption. Wonder why they did not do a trial run with a subset first or something. This could lose them a lot of members.
 
Damn this is a real stuff up. Grandfather is 90 with cancer and a member of Bonitas he just got released from hospital on Saturday, any longer and he would have been caught up with this nonsense.

Was thinking of changing to Bonitas this year and I'm glad I stuck with Discovery for now, got a new job and going to join CAMAF at the end of the year, hope they're better.

Hopefully this gets sorted out soon OP.
 
Bonitas has been on a downward spiral wrt administrative bungles for years now, so glad managed to convince the couple staff we have to move over to other medical aids a couple years ago before it got this bad.

Its important to spread the net for evaluating service to beyond simply one's own anecdotal experiences. The list of reported issues/concerns with Bonitas has been long and significant warning signs for years now.

Really feel for the people who now caught in the middle.
 
When I hear Bonitas, it makes me think of those "but wait there's more" tv ads.
 
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Reactions: SHL
MuterOfWorlds said:
Bonitas has been on a downward spiral wrt administrative bungles for years now, so glad managed to convince the couple staff we have to move over to other medical aids a couple years ago before it got this bad.

Its important to spread the net for evaluating service to beyond simply one's own anecdotal experiences. The list of reported issues/concerns with Bonitas has been long and significant warning signs for years now.

Really feel for the people who now caught in the middle.
Click to expand...
Personally we've never had issues in the past.
 
Anthro said:
To achieve the above objectives, claims for Bonitas members will be placed on hold from 1 -5 June 2026. Switching
channels will therefore remain closed until the exercise has been concluded. Claims placed on hold will then be released
and processed for inclusion in the Fund’s claims run of 15 June 2026.
Click to expand...
Seems from that letter that Bonitas knew that there was going to be delays on approvals from Momentum and let them do it.
 
RedViking said:
Personally we've never had issues in the past.
Click to expand...
Even a broken clock is right twice a day as the saying goes. Anecdotal, small sample size, personal experiences often miss a vastly darker underbelly of things going on.

There were plenty warnings on grander scale 2-3 years ago already that things were going wrong inside Bonitas administratively and was only getting worse, constant excuses, rather than clear intent to fix the internal failings.

I advised staff to leave them based on media reports, news, financial reports etc about Bonitas. The advice was purely about reports on Bonitas. I didn't push any medical aid on them, they were free to choose anyone else, I just shared all the media reports, financial reports, etc about Bonitas at the time, for them to decide.
 
I am changing from them to another medical aid.

Didn't have any issues before but now for a simple thing like not paying for my chronic medication wtf ?
 
Bonitas had forty years of administration by Medscheme who's system was built by highly qualified IT professionals with years of medical aid administration experience. What were the Trustees thinking?
 
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