Medscheme has pushed back against Bonitas’s explanation for the widespread service disruptions that followed the medical scheme’s transition to new administration and managed-care providers, arguing that it had repeatedly warned against the “clean-cut” transition approach ultimately adopted by the scheme and that the volume of queries encountered after go-live had been communicated in advance.
The response follows reports of widespread member complaints in the days after Bonitas’s administration migrated from Medscheme to Momentum Health Solutions and its managed-care functions transferred to Private Health Administrators (PHA) on 1 June.
As Moonstone previously reported, members complained of difficulties obtaining hospital and specialist authorisations, accessing chronic medication, reaching support channels, logging into digital platforms, and accessing medical savings balances. Some members reported postponed surgeries, delays in obtaining chronic medication, and lengthy call-centre waiting times.
Read: Bonitas members caught in service disruption after administration switch
In a statement issued on 3 June, Bonitas acknowledged that some members, healthcare providers, and intermediaries had “experienced challenges” following the transition. The scheme said that after go-live, a number of issues had come to light that it said had not been resolved during the final months of the previous administration. These included close to 10 000 outstanding matters relating to authorisations, savings refunds, claims queries and other unresolved requests. Bonitas also said data anomalies, particularly in historical member data, had exacerbated some of the challenges.
According to Bonitas, the volume of these queries meant teams that should have been focused on implementing the scheme’s future strategy had instead been required to deal with legacy matters. The scheme also suggested that slower-than-expected adoption of new digital platforms by stakeholders had contributed to delays.
Medscheme, however, says the situation should not have come as a surprise.
The transition took place against the backdrop of ongoing legal and regulatory disputes between the parties, including a section 44 investigation by the Council for Medical Schemes (CMS). Both Bonitas and the regulator have previously stressed that the appointments of Momentum Health as administrator and PHA as managed-care provider fall outside the scope of that investigation. The dispute was due to be heard in court on 9 and 10 June, but the matter has since been postponed because of legal complexities, with the parties awaiting a new hearing date.
Dispute over the transition approach
In a statement issued on Friday, 05 June, Medscheme said the “clean-cut” wind-down was explicitly requested by Bonitas despite Medscheme cautioning the scheme about the consequences.
According to Medscheme, a responsible wind-down would normally involve both parties working together to resolve queries during a transition period. However, it said Bonitas opted for a complete break, with final service cut-off taking place on 29 May 2026.
Medscheme said it consistently advocated throughout the transition planning process for a structured and phased approach designed to prioritise member continuity, minimise disruption, and safeguard access to healthcare services.
“The wind-down approach advocated for by Medscheme aligns with industry standards,” the administrator said.
“However, a decision was taken by Bonitas to proceed with a ‘clean-cut’ transition to its newly appointed service providers within a compressed timeframe.”
Medscheme said it had warned that such an approach could create operational risks.
“As anticipated and advised early on by Medscheme, this decision has regrettably manifested in the current risks faced by Bonitas’ members in obtaining authorisations for surgeries and other healthcare services.”
Query volumes ‘should not have come as a surprise’
Medscheme also disputed that the volume of queries encountered after go-live had been unexpected.
The administrator said that between 25 and 29 May, ahead of the final service cut-off, it provided Bonitas and the incoming service providers with daily updates on query volumes.
According to Medscheme, these updates covered the normal flow of ongoing Bonitas claims and authorisation requests generated by the scheme’s approximately 750 000 members.
“These volumes should therefore not have come as a surprise to the scheme or its new service providers as they are standard ongoing Bonitas claims and authorisation requests emanating from its 750 000 members that were communicated in real time,” the company said.
The statement contrasts with Bonitas’s earlier explanation that, following go-live, issues relating to approximately 10 000 outstanding matters came to light.
Member impact takes centre stage
Medscheme framed the dispute primarily as a member-impact issue.
It said the challenges reported this week highlighted the importance of placing member interests at the centre of major operational decisions and ensuring implementation approaches adequately account for the practical realities faced by beneficiaries and healthcare providers.
The administrator said it remained proud of the services delivered to Bonitas members over several decades and pointed to independently verifiable performance measures as evidence of its track record.
Medscheme also referenced comments made by Bonitas principal officer Lee Callakoppen before the transition. The company noted that Callakoppen had previously stated that the decision to appoint new service providers was unrelated to either price or service quality.
Support role continues
Despite the public disagreement, Medscheme said it had fulfilled all obligations under its agreements with Bonitas and would continue providing the agreed interim query-support function for unresolved matters originating before 1 June 2026.
The exchange leaves Bonitas members caught between two competing explanations for the disruptions that followed one of the largest medical-scheme administration transitions in South Africa’s history.
The debate is likely to intensify as Bonitas, Momentum Health and PHA continue efforts to clear backlogs and restore normal service levels.
