The Council for Medical Schemes (CMS) has received 46 complaints from Bonitas members following the medical scheme’s change of administrators and managed-care providers on 1 June, with two cases considered sufficiently urgent to warrant the regulator’s expedited investigation process.
Within days of the 1 June transition, Bonitas’s social media platforms filled with complaints from members reporting difficulties obtaining authorisations, accessing chronic medication, reaching support channels, and using the scheme’s digital platforms.
In its response to Moonstone on 25 June, Bonitas said service levels were “returning to normal levels on a daily basis”. More recent comments posted on the scheme’s Facebook page indicate that some members continue to experience difficulties.
In response to questions from Moonstone, the CMS said the 46 complaints were registered between 1 and 26 June.
The regulator cautioned, however, that the complaints cannot yet be attributed specifically to the post-transition service disruptions.
“The issues complained of date back prior to the scheme’s transition to the new administrator,” the CMS said, adding it would conduct further analysis of the contributory factors as investigations unfold. At this stage, all 46 complaints remain in the early stages of investigation, and complainants have not specifically identified the change in administrator as a factor.
The CMS confirmed it has corresponded via email with both Bonitas and Medscheme Holdings regarding the challenges experienced.
Asked whether it was actively monitoring the situation, the regulator said it was but noted that “the transfer of data is a contractual issue that needs to be managed by the parties concerned”.
Moonstone also asked what powers the CMS has where service disruptions affect members’ ability to obtain authorisations, chronic medication, or other healthcare benefits.
The regulator said that where there is evidence pointing to a contravention of the law, the Registrar of Medical Schemes may issue directives requiring compliance with the law.
Asked whether it had identified concerns that warranted regulatory intervention, the CMS is in contact with the scheme, and Bonitas has since communicated a plan to resolve the issue.
“The plan appears to be bearing fruit.”
A difficult start
The complaints follow one of the largest administration and managed-care transitions in South Africa’s medical scheme industry.
Before the 1 June go-live, Bonitas, Momentum Health and Private Health Administrators (PHA) repeatedly assured members, brokers, and healthcare providers that extensive planning, contingency measures, and enhanced governance had been put in place to support the transition. While acknowledging that challenges could arise, they said the focus would be on maintaining continuity of care and responding quickly should problems emerge.
On 1 June, Bonitas transferred its administration from Medscheme to Momentum Health Solutions, while managed-care services moved to PHA.
As Moonstone previously reported, members immediately began reporting problems obtaining hospital and specialist authorisations, accessing chronic medication, reaching call centres, logging into digital platforms, viewing medical savings balances, and obtaining savings refunds. Some reported postponed procedures, delayed treatment, and extended waiting times for assistance.
Read: Bonitas members caught in service disruption after administration switch
The transition also sparked a public disagreement between Bonitas and Medscheme over the causes of the disruption, with Bonitas attributing many of the problems to unresolved legacy matters and data anomalies, while Medscheme maintained it had warned against the “clean-cut” transition approach and had communicated expected query volumes in advance.
Read: Medscheme rejects Bonitas’s explanation for post-transition disruptions
Bonitas: Recovery continues
In its response to Moonstone on 25 June, Bonitas said significant backlogs had been addressed across several key areas, including claims payments and managed-care authorisations.
The scheme said the first batch of claims payments and healthcare provider payment runs had been conducted with positive outcomes and that further payment runs were planned “over the next few days”.
Bonitas also said on 25 June that “service levels are returning to normal levels on a daily basis”, and it had noted “marked decreases over the past week”.
“The vast majority of the backlog has been cleared,” the scheme said, adding that queries requiring additional adjudication represented less than 15% of the initial volumes.
Bonitas also said query volumes had stabilised across several key customer touchpoint channels, and it continued to operate within the requisite regulatory guidelines and adhere to the same, including the necessary scheme rules and governance aspects.
Asked whether complaints to the CMS had increased, the scheme said it had “not seen an influx of these concerns” and would continue responding to queries in line with its standard operating procedures.
Bonitas thanked members for the “grace and patience shown to us during this transition”, apologised for “any inconvenience caused”, and said it would continue to deploy additional resources to ensure it met members’ needs.
Bonitas also said membership levels remained stable.
“While there have been queries raised, our records indicate that the large majority of our members have not experienced any change in proceedings.”
Members say problems persist
Public comments posted on Bonitas’s Facebook page indicate that some members continue to experience difficulties.
The scheme’s most recent Facebook post, published on 17 June, asks members who have paid for healthcare services themselves to email their claims together with supporting documents for reimbursement. Public comments on that post have been restricted.
An earlier post, published on 3 June, remains open and continues to attract complaints, including several posted within the past few days.
One member, Caylin Fortuin, who said she was 38 weeks’ pregnant, described struggling to obtain authorisation for a Caesarean section despite having undergone two previous C-sections.
“I’m literally meant to have my birth on the 2nd,” she wrote. “I’m so scared to go to the hospital because I’m not sure if the hospital will get through to anyone to get an auth no… having a medical aid is meant to give you peace of mind… but the fear and stress I’ve been having while being on my last pregnant has been extremely difficult for me.”
Other recent comments referred to difficulties registering on the new app, accessing prescribed minimum benefits (PMB) care plans, obtaining chronic medication approvals, resolving rejected claims, and reaching consultants through the call centre.
One member recovering from major surgery said claims had been rejected while a chronic medication application remained outstanding.
Another, Deidre Zimri, questioned whether enough was being done to resolve the continuing complaints.
“Is anything actually being done about all these complaints, or are we all just getting the same automated replies?”
She added that members were “begging” for “a proper update and not just another standard response”, while a later post appealed directly to the scheme: “Please hear and read our cries. There can’t be this many complaints without real action being taken… We don’t need more automated responses, we need solutions!!!”
Another member wrote: “Today is the 25th of June and still we are experiencing all sorts of problems from Bonitas since the 1st of June… Smooth transition my foot.”
Additional resources deployed
In a joint statement issued on 25 June, Bonitas, Momentum Health, and PHA acknowledged that challenges had emerged during the early stages of the transition.
The organisations said, “no transition of this scale will happen flawlessly” and expressed the hope that “the worst of it is behind us”, adding that members could look forward to “a more enhanced experience going forward”.
They said more than 600 employees had been appointed, with a dedicated focus on supporting members, resolving queries, and ensuring continuity of care. Dedicated teams continued to work extended hours, while additional resources had been deployed across service channels to resolve outstanding matters.
According to the statement, significant progress had been made in reducing backlogs relating to savings refunds, hospital, and chronic medicine authorisations.
The organisations also said:
- more than 47 000 healthcare providers had been registered on the new Provider Zone, while provider onboarding continued;
- response times on the Bonitas WhatsApp support channel had improved significantly following the clearance of the initial backlogs; and
- more than 40 000 member registrations had been recorded across the Member App and Member Zone.
The statement added that Bonitas, Momentum Health, and PHA had maintained close engagement with healthcare providers, hospital groups, and other stakeholders throughout the stabilisation process. According to the organisations, those engagements had enabled faster identification and resolution of issues and strengthened collaboration across the healthcare ecosystem.
Bonitas, Momentum Health, and PHA said they remained fully aligned in their commitment to members and healthcare providers.
“Our focus remains firmly on supporting members, restoring confidence, and ensuring uninterrupted access to quality healthcare.”
