Bonitas members caught in service disruption after administration switch

Bonitas members are reporting widespread service disruptions just days after the medical scheme’s transition to a new administration and managed-care model went live on 1 June.

The complaints follow one of the largest healthcare administration transitions in South Africa’s medical scheme history. On 1 June, Bonitas officially moved its administration services from Medscheme to Momentum Health Solutions, while managed-care functions were transferred to Private Health Administrators (PHA).

In the months leading up to the transition, Bonitas, Momentum Health, and PHA repeatedly emphasised that the migration had been meticulously planned. Executives highlighted extensive testing, operational readiness exercises, provider engagement, and contingency measures, assuring members that benefits would remain unchanged, and measures were in place to minimise disruption.

However, complaints from members began surfacing almost as soon as the transition went live.

In a media statement issued late on Wednesday, Bonitas acknowledged that some members, healthcare providers, and intermediaries had “experienced challenges” following the transition.

The scheme said that, following go-live on 1 June, a number of issues had come to light that it said had not been resolved during the final months of the previous administration.

According to Bonitas, these included close to 10 000 outstanding matters relating to authorisations not being granted, savings refunds, claims queries, and other unresolved requests affecting members, brokers, and healthcare providers. The scheme added that data anomalies, particularly in historical member data, had exacerbated some of these challenges.

The scheme stated that given the large volume of these queries, teams that should have been “focused on taking the scheme’s strategy forward” had also had to deal with a number of legacy issues, forcing it to trigger contingency measures “that are already producing better outcomes”.

Another trend, according to Bonitas, was that despite communication efforts to ensure stakeholders were aware of changes in digital platforms, they had been slow to adopt them, causing additional delays.

Bonitas principal officer Lee Callakoppen said the scheme was working to address the issues.

“While we worked hard to ensure minimal disruptions ahead of the transition, these were unfortunate and unforeseen incidents that occurred after going live. We assure all affected members that we have already identified and are being actively managed.”

PHA chief executive Dr Ayanda Mbuli said that, as with any transition of this scale, some cases requiring intervention and escalation were to be expected.

“Our teams remain fully committed to resolving these matters as quickly as possible and ensuring continuity of care for Bonitas members,” said Mbuli.

Members report authorisation and access problems

Moonstone has received reports and reviewed dozens of public complaints from members alleging difficulties obtaining hospital authorisations, specialist authorisations, and chronic medication approvals. Members have also reported problems accessing medical savings, logging into the new portal and app, reaching support staff, and obtaining responses through WhatsApp, email, and call-centre channels.

Some members alleged the disruptions have left them without chronic medication, unable to obtain hospital authorisations and, in some cases, forced to postpone medical procedures.

Kenneth Waldron described the situation as “so unfair”, saying it felt as though everything had simply stopped, and no one was available to assist.

He said his wife had been scheduled to undergo an operation on 4 June, but the specialist’s office contacted them the day before to advise that the procedure could not go ahead because authorisations for both the operation and the hospital admission could not be obtained.

Waldron said the experience has left him questioning how Bonitas expected to retain members if the transition was handled in this manner.

One of the strongest criticisms came from Martin, who asked that only his first name be used. He said he works for a large specialist medical practice, and his mother is a Bonitas member.

Martin alleged that PHA’s managed-care system had been unavailable for much of the time since 29 May, and healthcare providers across Kimberley had been unable to obtain authorisations or confirm benefits.

“I work for a massive specialist practice, and all the hospitals in Kimberley, all specialists and radiology/pathology are currently unable to obtain any authorisations nor are they able to confirm any funds,” he wrote.

By late Wednesday, Martin said some systems appeared to have come online partially, with authorisations once again being processed telephonically. However, he said waiting times remained “excruciatingly long”, and hospitals were still dealing with substantial backlogs.

He said he had confirmed with a staff member at a private hospital that some facilities were obtaining reference numbers directly from Momentum’s member services department rather than through PHA in an effort to avoid late-authorisation penalties. According to Martin, patients could still be required to assume temporary responsibility for accounts if authorisations could not be obtained in time.

Although critical of the implementation, Martin said he understood the rationale behind the transition and the reasons for regulatory pressure to separate administration and managed-care functions. However, he believed the implementation had created significant operational challenges for providers and members.

Dozens of comments posted on Bonitas’s Facebook page reflect similar frustrations.

One member, Ricelle Henning Whelan, described struggling to obtain an authorisation for a hospital admission.

“Have been trying for the last 24 hours for authorisation for someone who needs to be admitted to hospital, no answer. Terrible Service, you messing with peoples lives! [sic]”

Another member, Waseemah Hanslo Gabriels, said her husband’s scheduled surgery had been affected.

“We have been trying continuously. This is so disappointing. None of the agents respond [sic], we are waiting for five hours in the queue. My husband was scheduled for surgery today. We still received no response for days.”

Esthernita Ukena reported that she had made 10 calls in an effort to obtain authorisation.

“Had to postpone operations due to your transition.”

Several complaints centred on access to medication.

Roshan Lil-Ruthan wrote: “The worst experience ever for the thousands I pay monthly!!!! 5 days without chronic medication.”

Phontle Tabata said she had visited four pharmacies without success.

“The claim keeps on getting rejected … It is now the second day I am without the medication that I desperately need.”

Others described problems with medical savings balances that appeared not to have transferred correctly to the new platform.

“Leoncarlamia” Nell said her savings balance appeared on a statement issued before the transition but was not available at the pharmacy.

“Worst of all, they are not communication [sic] to us to take note that the pharmacy issue medication on basis that your savings is depleted … which mean we pay full price for medication.”

Frustration with the new digital systems was another recurring theme.

Debbie Oosthuizen described a cycle of repeated registrations, logins, and OTP verifications when trying to access hospital authorisations online.

“You register. You then try log in, get OTP. Enter OTP. Back to Login screen. App is frozen.”

Members also complained about long call-centre waiting times, dropped calls, and WhatsApp conversations that appeared to stall indefinitely while awaiting transfer to human agents.

Across these multiple complaints posted on Bonitas’s Facebook page, members were repeatedly met with the same reply from the scheme:

“We apologise for the delay in communication. We are sad to hear we disappointed you. We want to make a difference in every member’s life and strive to give the best possible service. Kindly DM us your membership details and detailed query for further assistance.”

Bonitas outlines steps to address backlog

To address the backlog, Bonitas said it had engaged broadly with key hospital providers to help ensure members continued to access care, particularly in emergency situations. The scheme said Momentum Health and PHA had also invoked additional capacity within their organisations to support the resolution of these queries.

Momentum Health and PHA had also extended their operating hours by opening one hour earlier and closing one hour later each day to assist in addressing the backlog. Bonitas added that additional hours and resources would be deployed over the weekend to support these efforts.

Bonitas said it continued to engage and communicate with key stakeholder groups as efforts to resolve the backlog continued.

The scheme said dedicated teams across Bonitas and its partners were working around the clock to address reported issues and restore normal service levels “as quickly as possible”.

Bonitas said its priority remained ensuring members could access the healthcare benefits they need, including treatment, medication, and support, with priority being given to urgent and clinically sensitive cases.

Bonitas said members who have had to pay for medication, treatment or other healthcare services out of their own pocket because claims or authorisations could not be processed will be able to claim reimbursement through the normal claims process.

Members must submit their claims together with proof of payment to claims@bonitas.co.za. The scheme said it would then assess the claim in line with the member’s benefits and the scheme rules before processing any reimbursement.

Bonitas did not indicate what turnaround times members could expect for reimbursement claims.

Transition assurances under scrutiny

The disruptions stand in contrast to the assurances provided ahead of the transition.

In the weeks before go-live, Bonitas, Momentum Health, and PHA repeatedly emphasised the scale of the planning behind the handover.

Callakoppen said Bonitas had built extensive governance, oversight, and contingency mechanisms into the transition, including real-time monitoring of service levels, escalation structures, high-frequency reporting, analytics, and a post-launch “hypercare” model.

Read: Bonitas: administrator change is part of a wider repositioning

Niyaaz Ebrahim, executive head for Bonitas’s business unit at Momentum Health, said the administrator had completed extensive testing, recruited and trained staff, strengthened support capacity, and established fallback arrangements, including an off-site call centre. He said Momentum Health was “functionally ready” for the go-live.

Read: Bonitas move: Momentum Health sets out the operational playbook

PHA, meanwhile, said it had built its transition programme around people, technology, and processes, pointing to provider engagement, stress-testing, phased data transfers, and contingency capacity as evidence of its readiness to take over Bonitas’s managed-care functions.

Read: PHA lays out its case as Bonitas managed-care handover nears

In the statement issued late on Wednesday, Bonitas said it had considered a range of factors in preparing and planning for the transition, supported by project-management methodologies, and governance assurances.

“Our aim was to ensure that our stakeholders were not adversely impacted. It is for that reason that we deployed a collaborative and systematic approach for the wind-down and transition with all concerned parties,” the scheme stated.