Bonitas
Gynaecologist annual check up not part of formula

I was referred to my Gynaecologist by my GP for my annual check up. I got to the Gynae, he did the check up and referred me for my first mammogram. These accounts was submitted it to Bonitas- Boncap. Assuming every will be paid for as these was both routine checkups. To my shock some these accounts were not paid. All that was done is routine tests and examination and I find it very disturbing that the medical aid did not pay. Why do I have a medical aid if I have to pay accounts out my pocket? I forwarded a mail to [Email Removed] to enquire as to why the accounts were not paid in full. Here's the details of the accounts: R371.00 was claimed and R287.80 was paid and R83.20; R559.70 was claimed for and was rejected due to the tariff code not being on the formulary. Amount of R986.80 was received, processed and rejected due to the tariff code 34100 (X-ray mammography including ultrasound) not being on the formulary. I checked my statement now and see I have a benefit for circumcision: WHY DO I HAVE A BENEFIT FOR THIS BUT NOT FOR MY ANNUAL GYNAE CHECKUP AND MAMMOGRAM??? And there's a benefit for: out of area benefit. Why can't my accounts be paid in full??

Company: Bonitas
Country: South Africa
City: Boncap Beneficiary Manag

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