Internal Prosthesis benefit LIES
Good day, HOW is it POSSIBLE that the Primary select option I am on has an internal and external prostheses benefit of R33 220 but the fund refuses to use this benefit as payment for internal anchors and *****s used in my husbands shoulder surgery.  ALL THE ATHORIZATIONS were obtained prior to the operation and on the documentation received it clearly says that the shoulder anchors will be covered up to the internal prostheses benefit limit.  This was not a selective operation.  His shoulder was unstable due to a dislocation, it had a large anterior labrum tear, which could not be repaired without surgery.   Without full function of his dominant shoulder he will not be able to continue with his line of work.  I have sent numerous emails, chats, calls prior and after this operation to make sure that we were covered and now still the fund refuses to assist me.  We have been loyal BONITAS MEMBERS since 2013, and now when we need them to pay treatment they refuse.  8 years of paying for this benefit of internal and external prostheses and now the first time we need to make use of this benefit, they don't pay.  I am very disappointed.  How can I have a benefit of R33220 but they wont use it for payment.