Medical aid pays deaf man’s claim after Dispatch article

Bonitas medical aid scheme has confirmed that it will pay for a cochlear implant for East London journalist Tim Stones.

The scheme sent an e-mail on Tuesday stating that “the claim has been reprocessed and the fund will pay an amount of R 277,700, to the healthcare provider on the next payment run date”.

Stones, a journalist for the Daily Dispatch, has already paid an amount of R6,901 to the service provider, based on his knowledge of his medical aid benefits and a pre-authorisation letter issued by Bonitas on February 14.

The Dispatch reported on Tuesday how Stones’ hearing loss was traced to oxygen deprivation at birth. He received a cochlear implant in his left ear – he wears a powerful hearing aid in his right ear – during surgery at St James hospital in April.

While Bonitas paid for aspects of the surgical procedure – including accounts for the hospital and surgeon – Stones grew increasingly concerned when the medical aid specifically declined to pay for the technology implanted into his left middle ear and an external processor.

Efforts to communicate with the medical aid scheme proved fruitless until yesterday morning when, hours after the Dispatch article appeared, Bonitas informed the newspaper that the claim would be settled in accordance with the benefits.

The scheme did not say why it had declined the claim for implant technology after issuing pre-authorisation.

In a follow-up e-mail, a Bonitas consultant said the claim had been declined initially because “the system processed the claim incorrectly”.

She claimed the scheme had informed Stones on May 23 that it would cover the outstanding claim. However, Stones said yesterday he only received an e-mail stating the claim was being processed, with no guarantee of payment.