More than two months after Bonitas moved its administration from Medscheme to Momentum Health Solutions and its managed-care function to Private Health Administrators (PHA), the worst of the disruption appears to be over – but providers and members are still dealing with unpaid and short-paid claims, authorisation problems, tariff discrepancies, and delays in getting issues resolved.
There has been clear improvement since the 1 June “clean cut” transition. Calls are being answered faster, hospital authorisations are being processed, and claims are being paid. Bonitas says its operations have stabilised significantly, and member perceptions of its service have improved.
But those improvements have not removed the problems providers are still reporting.
The Radiology Society of South Africa (RSSA), which represents radiologists and has been engaging with Bonitas, Momentum Health, PHA, and Health Calibrate since the transition, says the initial problems have “not been substantially resolved”. These include short-paid and unpaid claims, authorisation-related rejections, inconsistent tariff application, old claims still needing to be reconciled, limited information on the Provider Zone, and poor call-centre support.
“The initial problems have therefore not been substantially resolved,” says Dr Richard Tuft, executive director of the RSSA.
A source who asked to remain anonymous because of the sensitivity of the issues and their escalation to other professional bodies also described a similar mix of improvement and frustration. The source has professional experience dealing with healthcare providers and direct experience of Bonitas from the provider and member sides.
The initial problems with the systems and PHA’s managed-care function have improved significantly, but claims are still being incorrectly processed or paid, while some PMB authorisations remain difficult to resolve.
Bonitas says the scale of the recovery is reflected in the numbers. Between 1 June and 31 July, it handled 342 419 member calls, processed 45 450 hospital authorisations, provided chronic medicine to 166 791 members, and paid more than R2.9 billion in claims. Average call-answering times improved by 79%.
More than 600 employees were recruited, onboarded, and trained as part of the recovery programme, with additional claims assessors and back-office staff brought in. Bonitas also says independent survey results show a 20% improvement in members’ perception of its service, particularly around authorisations and managed care.
The immediate crisis has eased. The question now is how quickly the remaining problems can be sorted out – and whether providers and members will see the improvement in the day-to-day handling of their claims, authorisations, and queries.
Providers are still chasing payments
Bonitas says claims processing and provider payments have stabilised significantly since the early stages of the transition.
Claims are being processed and paid daily, with more than R2.9bn paid during June and July. Additional claims assessors and operational staff have been added to deal with outstanding exceptions.
But Bonitas also acknowledges that some claims still need further review because of data, tariff, or other administrative issues.
That is consistent with what the RSSA is hearing from radiology practices.
Its members continue to report short-paid and unpaid claims. The RSSA says the consistency of those reports across practices and regions suggests a systemic problem rather than a handful of isolated cases.
It believes differences between the tariff files or Rand Conversion Factors used across the PHA, Health Calibrate, and Momentum Health systems are a significant cause.
The anonymous healthcare professional describes similar problems, including account short payments caused by incorrect tariff processing and difficulty getting those payments sorted out.
Bonitas says where a provider or member raises a concern about a particular claim, there are escalation processes in place to deal with it.
And where an administrative or claims-processing error results in an incorrect payment, Bonitas says the case is reviewed and corrective action taken where appropriate.
It also says members should not be unfairly prejudiced by an administrative processing problem.
The RSSA takes a similar position on incorrectly short-paid claims: where the problem is caused by an incorrect tariff file, RCF, code mapping, or processing error, the claim should be corrected and the provider paid.
It says it has not received evidence that practices are generally passing those erroneous shortfalls on to patients.
Radiology is still working through the tariff problem
Radiology has become one of the clearest examples of what remains unresolved.
The RSSA supplied Bonitas’ existing 2026 radiology tariff files and Rand Conversion Factors (RCFs) to Momentum on 3 June. Momentum subsequently told the RSSA that these had been accepted by Bonitas and loaded, apart from one PET-CT code.
Yet practices continued to report short-paid claims and other payment discrepancies.
As recently as 14 August, the RSSA says, Momentum indicated that feedback on rate adjustments was still awaited.
The RSSA says different RCFs apply depending on the member’s benefit plan and the imaging modality. It is working to ensure that the radiology benefits that applied before the transition continue to be applied correctly and consistently.
The RSSA says its understanding was that the existing 2026 Bonitas RCFs would continue to apply during the transition.
Bonitas says it continues to honour its contractual commitments and that payments are administered according to applicable provider agreements and agreed payment arrangements. For specific payment arrangements, however, it refers providers to Momentum Health and PHA.
Bonitas also acknowledges that providers have raised queries about radiology tariffs and payment outcomes. It says these are being investigated to establish whether differences relate to contractual arrangements, system configuration, claims-submission requirements, or processing rules. Where corrective action is required, it says this is implemented through the relevant operational channels.
The authorisation problem has changed, but it hasn’t disappeared
Hospital authorisations were among the biggest problems in the first weeks after the switch.
There has been progress. Bonitas processed more than 45 000 hospital authorisations in June and July and says authorisation and managed-care services have improved significantly.
The RSSA agrees that things are better.
But its members are still reporting that some pre-transition authorisations are not recognised. Authorisation numbers on the Provider Zone can differ from those on authorisation letters, and claims can be rejected for “no authorisation” even where a valid authorisation was obtained.
There are also cases where incorrect treating-provider or facility information prevents a claim from matching the authorisation.
Fixing these problems can mean repeated calls and lengthy follow-up.
PMB authorisations are an especially sensitive area.
The anonymous healthcare professional says most radiology information can now be loaded online, but turnaround times remain slow. Getting a confirmed PMB condition authorised by telephone can still take weeks or, in some cases, months.
The RSSA has not separately quantified how many of its reported authorisation problems involve PMBs. It says, however, that an administrative problem should not prevent a member from receiving the benefits to which they are entitled.
Bonitas says PMB-related cases receive focused attention through dedicated clinical and operational teams. Where delays are identified, cases can be escalated for expedited intervention.
Emergency claims are another unresolved question
There is also a concern around emergency and casualty claims.
The anonymous healthcare professional told Moonstone that a contact at a private hospital had reported a significant problem with unpaid emergency-room claims since the transition.
The source would not identify the facility, and Mediclinic did not respond to Moonstone’s request for comment.
The source also said that some private practices were reluctant to treat Bonitas members, while others were asking members to pay cash upfront and claim the money back from the scheme.
Bonitas says it remains committed to ensuring access to emergency medical care and that emergency claims are processed according to the scheme’s rules and legislative requirements.
It says it has continued engaging with hospital groups and healthcare providers about operational problems arising from the transition. Where specific emergency or casualty claims are raised, these are investigated through its existing escalation and payment-review processes.
The source said private facilities in the area are still treating Bonitas members, but concerns about outstanding claims remain.
Bonitas is also aware that some members experienced problems with providers, authorisations and claims during the early stages of the transition. It says these cases are being monitored and escalated where access to care is affected, particularly where treatment is clinically urgent.
Members are still feeling the effects
The problems on the provider side are showing up in members’ experiences too.
The anonymous healthcare professional says a family member who belongs to Bonitas has experienced problems with medication payments and the Health Benefit Booster, including over-the-counter medication being rejected as member liability despite money remaining in the benefit.
That is one member’s experience and cannot establish a wider trend.
Bonitas says it is aware that some members experienced problems with medication claims and certain benefit categories during the early stages of the transition.
It says most of these problems have since been addressed through system improvements, operational interventions and additional resources, while remaining issues continue to be monitored.
But communication is still a recurring complaint.
The anonymous provider describes incorrect claims payments and “little to no communication” about member and provider queries as among the biggest unresolved problems.
The RSSA is also still hearing complaints about poor call-centre support and inadequate information on the Provider Zone.
Better than June, but not there yet
There is no question that Bonitas has moved a long way from the first weeks of June.
The numbers show it. Claims are being paid, authorisations are being processed, chronic medication is reaching members and call-answering times have improved sharply.
Bonitas says the operation has stabilised and that member perceptions of its service are improving.
Neither the RSSA nor the anonymous healthcare professional is disputing that there has been progress.
What they are saying is that the remaining problems are now showing up in the details: the tariff loaded against a claim, the authorisation that does not match the system, the payment that is short or missing, the old claim that still needs to be reconciled, and the query that takes too long to resolve.
The South African Medical Association (SAMA) has also declined to comment for now. It says its leadership is due to meet with Bonitas to discuss challenges experienced by its members and that it would be premature to comment before those engagements have taken place.
The RSSA’s assessment is perhaps the clearest measure of where things stand.
“The practical measure of whether the transition has stabilised is whether practices can obtain reliable authorisations, submit claims, receive correct payment, and reconcile their accounts. On that measure, the transition is not yet operating at an acceptable level.”
I find it impossible to get any assistance with my Bonitas queries. I am unable to take ti anyone or any other device. My simple requests are not ans
Same here. Absolutely no reply to queries and help desk takes forever to answer. I don’t have unlimited airtime !
Couldn’t agree more, in 1 week I was on the phone to Bonitas for 45mins over 3 days. My daughters claims are still not sorted. We are seriously thinking of moving medical aids.
Same here have been battling 3 months with my cronic meds😕
Waiting for a PMB query to be resolved for more than month and half, reference number on reference number!
Lack of feedback on emails,other than reference numbers!
I am experiencing the same with my chronic application as well with a refund. No response to my emails besides reference on reference.
I have the same problem PMB consultation visits paid through our savings instead of PMB benefit and it’s 3 months and so many escalation i cant count and still not resolved. Thinking of moving to another medical aid. Medscheme was on the ball Momentum is bloody useless they don’t know what they are doing.
The new administrators are worst than the ANC on service deliveries.
I have twice this year gone to medical assessment for the R5000 over the counter medication benefit and it is still not loaded on my portfolio resulting in me paying R300 for flue medication.
Please wake up I am a pensioner paying nearly R7000 pm on Standard and then still pay in full for OTC medication.
Should I change to another medical scheme or are you going to get your ducks in a row ?
Ons is ook pensioenaris en op Standard plan en betaal oor die R11.000 vir my en my man
My email address was removed from our correspondence
We have not been advised if our health boosters have been approved after we went for it almost a month ago
My email address was removed from the correspondence
We received no reply to our health benefit booster after we went to clicks almost a month ago
No reply to emails send
The monthly member statements are ridiculous! No break down or details provided anymore. You have to guess benefit balances, or worse, you have to call them! The whattsap portal is hopelessly badly designed
Agree! Prefer the Medscheme statements with the explanation codes.
Yes this is my biggest beef with them too. Their claims statements used to be so clear and easy to deal with. Now its like all guess work. Talking to their bot is utterly ridiculous , it can only refer you to an agent but then there is no agent available so you keep going round in circles. I had to tell them the other day that it was honestly bad for my health dealing with my healthcare insurance. Which is crazy!!
I cannot make head or tail of the member statements they are vague and not transparent. No breakdown or anything and the agents on WhatsApp have no idea what they are talking about am so over Bonitas.
Still some problems not paid and wrong authorization but very soon is going to be everything back to normal
End May member statement and end June member statement there is an R28.28 difference where Momentum did not pay. The same chronic medicine.
Very frustrating, you must pay upfront to see any specialist, there is no more preferred service providers you can see without paying upfront and all this changed when momentum came on board
Nothing has changed. Momentum is treating Bonitas clients as if they are on Momentum Health medical aid which has been and always will be one of the worse medical aids to be on. I get no help or response from them and since when has babies been put on waiting periods. Since I’ve known and been on Bonitas no baby or toddler was on a waiting period. Bonitas promised us no changes will happen but Momentum surely is treating us like Momentum Health clients. Bonitas will definitely loose clients now. Biggest mistake was to move to Momentum health
I’m a client and I’m worried Bonitas we had good relationship but now they destroyed my family took extra money from my premium R5000 and suspended my medical aid while still taking my monthly payments.
I am canceling my Bonitas membership after many years.
The fees increased with 7.8% and day to day benefits disappeared into whats available in savings. They refuse to pay chronic medication and service providers on their app does not correspond to the website.
I am switching to Discovery
I have an Oncology claim that is for procedures done in May!! On issue is the simple fact that the Momentum claims processors don’t know what the Oncology code C20 means and this is not the first claim with this problem . I’m being threatened with legal action because the incompetence of these people.
Bonitas still pay benefits from my annual benefits instead of the approved PMB approved conditions. This result in my benefits now been exhausted and suppliers not been paid. I struggle since 2 July 2026 to have it rectified but with no results.
I received prescibed medicines now for 5 months with no co-payment. Suddenly in the 6 month there is now a 30% co-payment which no-one can explain. I have cancelled the medicines as I can not afford the co-payment.
I leave Bonitas the end of year and Momentum staff are also very unhelpful These people have no commen sense
Bonita’s there is no improvement u guys have failed the members, I am sitting with bills and hospital co payments which I never paid before, come Nov and u will see a drastic drop in members moving away to other service provider. Momentum administration does not know there left leg from their right when taking our calls. Stop talking nonsense u guys have failed
When i heard that the administration is moving over to momentum, i said here starts our problems. Momentum is all about profits and not the members. The services of Bonitas has gone down the drain, just because of the change. Surely any major medical scheme should have anticipated problems and should have addressed the obvious ones before the hand over. This is not just about momentum, but Bonitas should have done their homework better. Correct me if I am wrong, but momentum is not a new player in this field. It is all about the money and the members are going to be the lovers at the end. Bonitas can loose a lot of members, if the are not going change the administrators or their strategy about business. The one cannot exit without the other.
Thanks
I received hospital authorisation for my husband’s sleep apnea however all payments relating to his treatment is taken from savings. Gave up trying to resolve with Bonitas. The call centre agents do not even understand the medical terms.
I have been with Bonitas for many years. I requested membership certificates because I need to move to another medical aid. The service from Momentum is pathetic. I was asked to call Medscheme for my previous years membership certificates. Medscheme says we are no longer the administrators please contact Momentum. I have been emailing Momentum twice a week only to get the same message over and over. Please refer your query to Medscheme for your membership certificates. The problem is not only with claims. It is with membership and contribution. After many years on Bonitas. I’m moving to Discovery. I just can’t deal with agents that don’t know what they doing. Bonitas made a big mistake to move administrators. They will definitely loose members by the end of this year.
I work in a Radiology practice and simply getting no joy !!! This has been and still is a disaster. I personally was a Bonitas member but now have moved to another scheme.
The lies!! There is nothing better.
I have been struggling with PMB claim being linked to Savings for more than 2 months.
Every time I called, is “thank you for your patience” “apologies for the inconvenience” only for the claim to be declined again even though they can see their error.
I eventually paid the provider and had to be a mad person for more than 2 hours so that no body “escalates” the matter one more time for it to be declined for the 100th time… Only for you to “mistakenly” paid the provider after providing proof of payment 3 times.
Even the IA WhatsApp chats are proof that our health means nothing inspite of the high premiums we pay.
And then they tell you there is no direct line to claims department, yet emails are not responded to
I thought I was the only one considering leaving, but the comments have valided me. I can’t wait for year end to change
2nd Day with another claim for dame procedure!! Insufficient funds as reason but more than 85% of original benefit still available. Consultants excuses are all the same. “Noted, we will address it”
Statements are actually a waste of time to look at and consultants just states that it is a system error!!!
PLEASE, BRING BACK THE PREVIOUS ADMINISTRATORES, BONITAS MEMBERS ARE PAYNG THE PRICE.
So true. They were the best. My debut order was cancelled with no notification after I was debited twice. Pathetic service . I don’t know what to say about the monthly statement. No breakdown.
Worst medical aid ever. No response. No statements. Not sure what is paid and what is not. Think of changing the end of the year after almost 15 years. Bonitas you can do much better. Disappointed!!
An absolute disaster!!! Struggling since June to sort out paymenst to providers. Covers no over the counter medicine anymore. For years been a loyal member. Definitaly cancelling with Bonitas. The amount I pay each month and theydon’t want to cover anything anymore. Totally useless
My claims are not being paid. I had to stop seeing my psychologist as I can’t afford the payments anymore which has a big impact on my mental health but Bonitas can’t care less as long as they get payment every month.
Bonitas is not honouring the contract that we had with Medcheme and all our account are short paid and we were promiced a month ago that this whould be delt with and had not been done. We cancelled our provider contract with Momentum as we are not prepared to deal with them at this stage because what they are offering the doctors much less then what they got from Medcheme. It is sad that it has to get to this as Momentum has now made it worse for the patients that will now have to pay privately because of contracted out fees.
No i can’t agree struggle with some accounts from June then they told me they didn’t receive the claims we re-submit the accounts again receive refference numbers but with no luck. I was also at the walk in centre they help me but didn’t receive any feedback from Bonitas again. The medical dr’s phone me now for the money. We never struggle so much with claims i’m not happy on the moment with Bonitas
i can’t agree with what Bonitas is saying I’m still struggling to get abdomen binder processed after doing umbilical hernia operation in june.up until now you don’t get a satisfactory reply from them…this has caused me more stress cause one is not able to slee at night because of the mesh installed inside my tummy…it’s so frustrating…they dont even care
I phone the oncology department three times and every time they put me on hold. I could hear them talking and singing in the background. After twenty minutes I had to drop the call. The third time they put me through to people that don’t know Bonitas. This is really a disgrace.
Was admitted in June 2026. Alot of bills have not been paid. Sleep apnea machine authorization not received. Cannot go and get check by pulmanologist, physiotherapy, mediation becoz funds are exhausted. So have to pay cash. This never happened before. Now am thinking of leaving Bonitas after 27yrs. They going to loose clients.
I’ve been trying since 12 August to get hospital authorisation. Called more than 3 times and was also on bonitas chat box. No help, had to drop call after more 40 minutes each time. Eventually call was answered on 12 August just to inform me phone back following day, no ref numbers, just take name and date of call.
Went on until 13 August, after 3 phone calls of more than 30 minutes each. Was informed to submit motivational letter from Dr which I did. Phoned and emails again on Monday, 17 Aug, was informed to phone back after 10, then after 12, then the following day which I did. Phoned again following day as my procedure was due on 19 Aug. They only approved certain codes, the agent told me wait 48 hours after I’ve been trying to authorisation since 12 of Aug. Pathetic service, looking for reasons to reject claims while playing with members lifes. I’m done with Bonitas and will report them to the Medical Council
I have submitted spectacles claim to be paid from savings only to be told that they don’t gave enough assessors to pay my claim manually .
Pathetic service, can the PO reverse this bad decision
Hello. Am unable to download Bonitas App since 1 June and they say my ID No those don’t exist on Bonitsa but I pay every month. Its really stressing us like I don’t know how much I have for my savings. Itjoo Bonitas is worse I am moving to Discovery this December.
Really the worst decision was to migrate administrators. I am/was a DSP on Bonitas and this is the worst experience from any medical aid. Of claims submitted since June, I have probably 90% unpaid claims. Of the 10%, numerous capture errors, incorrect payee’s, short of DSP payment arrangements and needless to say, basic self checking functionality like claims monitoring in non existent on PHA’s provider portal. Absolute shambles
Also changing medical aids for entire family. My friend Pam and hubby also doing so end of year. Im sure many more. From chronic meds having big copayment to no communication. We will take our money elsewhere
Medical details were also not uploaded to the SARS system so when tying to finalise 2025 tax it was found this can’t be done without the medical aid details. Bonitas is sending us from pillar to post with no clear answer or fix
Medscheme was much better. Get legal advice with your issues.
Sadly I must agree to almost all the complaints listed.
Statements difficult to figure out; Short payments or no payment of claims at all. Obtained authorisations just being ignored or rejected; Most of the times unable to reach the helpdesk by phone; Not replying to queries besides giving automated references which are after 14 days still not responded to. Getting confused with different medical providers and or dates of treatment !
To many reasons to really understand why Bonitas had to move to Momentum at all. This is a very big problem and should not have been the case 😵💫
Lies! The CEO should do the honorable thing and resign. I am a member of the standard plan and I am according to Bonitas a Bon cap member, their most basic plan. They are uncontactable and have collapsed administratively. Let’s not even get to why the Council for Medical Schemes is not placed them under administration. Fortunately I can leave at the end of the year. But what if something happens that needs urgent action on Momentum Life 1000 new untrained and inexperienced staff.
I have been on Bonitas for 24 years. I have never had problems until now. My husband was injured and needed hospitalisation, surgery and follow up care to the orthopaedic surgeon and physiotherapy thereafter. I a pensioner had to pay cash for all physiotherapy sessions and even for the doctor’s visits after hospitalisation. Less than one third of hospitalisation, radiology and orthopaedic surgeon bills have been paid over the last 2 months. I am one of the members who gave Bonitas excellent ratings. Now I can’t wait for the end of the year to move to another medical aid. Very 😞😞 Getting through via telephone … Nil. Getting feedback via email.. oh yea just a reference number and then nothing.
Bonitas is psthetic!!!
I have been a Bonitas member for 29yrs. I have been battling since 8 August for a Membership tax report for SARS. I have sent emails upon emails with no response. It’s no rocket science to draw this document. Why move the administration?? Why fit something that is not broken. Bonitas is going to lose a lot of members!!
Its all very well Bonitas addressing problems with paying claims on the discretionary benefit 2nd opinion offsite specialist radiologist report BUT the systemic issue imposed with digital controls in 2012 – for administrators to manage scheme payments due to the clinical imaging practices on the alternate re-imbursement model for schemes – when is the centralised system fix to be reversed, Bonitas? Who authorised the insurance-based 38% vs 515% between clinical and administrative/non-clinical providers. At 53 years since the licensing regulations commenced who is actually authorized to use x-ray equipment licenses?
How does Bonitas expect someone with Chronic Conditions to wait for authorization and for it to be added as a PMB…..it’s called a chronic condition for a reason and that medication is needed urgently….being a paraplegic and needing your medication becomes a live or death situation….that condition will never be fixed…..SO AUTHORIZE MY MEDICATION PLEASE ….IT’S NOT GOING TO CHANGE AND I HAVE THE SAME FIGHT YEAR AFTER YEAR…..GOING ON NOW FOR 9 YEARS !!!
I took Bonitas 3 months to settle a lancet claim where lancet was harrassing daily for payment due to Bonitas sort paying on PMB, vital tests which falls part of ongoing management was being rejected.
I was also affected by the benefit booster being blocked, reason deactivated. That alone took over 2 months to sort as well which result in out of pocket expenses
Bonitas promised enhanced systems, streamlined processes and support designed to deliver a smoother, faster and more efficient experience and a carefully managed transition with dedicated support, clear communication and minimal disruption to ensure continuity throughout the process.
None of the above happened. It has been an unmitigated disaster for members and Health Care Providers who have been caught in the middle of very poor decision making by Bonitas.
One is now very scared of needing medical care because your medical aid can no longer be relied on.
I still have a gamble at the pharmacy getting over the counter meds that used to go through before the administration change that are not being approved.
It’s a struggle everytime crossing my fingers if Bonitas will pay. They even did not pay Benelyn cough syrup. Allecet pills and many schedule 1 drugs . It’s frustrating and they are not resolving their mess.
Totally agree with all above, statements are non explanatory, 3 day answers are never answered, where are the 17 walk in centres, when asked on the bonitas site they refer you to a medscheme walk in centre, what a mess. It shows there staff are not trained.
The story of stability is a lie , non of the emails sent to them have been replied to regarding the issue of non payment to Doctors/Specialists/The Hospital ect for my now deceased mother who was admitted 2 months at Milpark since May 2026. To date we keep receiving mails and sms from Drs chasing their outstanding payments and even threatening legal action against my Dad who is a pensioner and currently dealing with the traumatic situation of losing his wife. The medical aid has not even sent a claims report to date even post asking through several mails. This is appalling to sat the least and seriously disgraceful.
I have a small medical claims bureau and struggling eith unpaid, shortpaid, pmb claims not honored and must forward email after email, physio tariff modifiers are applied incorrectly by the scheme and no progress!!
In hospital physio claims are NOT being linked to hospital auths thus claims remain unpaid, case managers should see that this is done.
Absolute mess