Members of Bonitas medical scheme are up in arms over unresolved queries and hospital authorisations after it changed administrators earlier this week.
Bonitas is South Africa’s second-largest open scheme, with 750,000 beneficiaries, making the switch in administration companies the biggest the industry has seen yet.
Bonitas has blamed its members’ woes on its previous administrator, Medscheme, which in turn has pointed the finger at the new service providers, Momentum Health and Private Health Administrators (PHA). Medscheme and Bonitas are already mired in conflict, as Medscheme took Bonitas to court last year over its planned change in administrators, alleging tender irregularities.
Earlier this week dozens of Bonitas members took to social media to air their complaints, many of which centred on distressing delays and a lack of response to authorisation requests after the new service providers took over on June 1. Medical schemes require members to obtain prior approval for some planned procedures and hospital admissions, as well as costly tests and treatment.
Bonitas principal officer Lee Callakoppen blamed Medscheme for the disarray, saying it has handed over an unexpected backlog of more than 10,000 outstanding matters. The backlog includes queries about claims, authorisations that had not been granted, savings refunds and affected members, brokers and healthcare providers, said Bonitas. Anomalies in historical member data compound the challenges, it said.
“Teams are working around the clock to resolve issues and get to normal service levels,” he said.
Bonitas anticipate the backlog will be cleared by Monday, he said.
PHA CEO Ayanda Mbuli said the company received hospital authorisation data files later than agreed and an unexpectedly large volume of unresolved matters. PHA, which provides managed care and hospital authorisation services, received more than 7,000 open authorisation and case management items on May 30, with a further 7,000-plus cases handed over on June 1, she said. For a scheme the size of Bonitas, PHA would normally expect 1,700 such queries a day, she said.
“While significant progress has already been made, the volume of cases means that resolution is an ongoing process. We continue to monitor volumes daily, prioritise urgent clinical matters and adjust resources where necessary to accelerate the clearance of the backlog,” she said.
Medscheme hit back, saying it warned Bonitas against opting for a clean break, with a final service cut off on May 29. “Typically a proper wind-down would involve both parties working in conjunction to resolve queries,” it said.
Medscheme said it has provided daily query volume updates to Bonitas and the new service providers from May 25-29 to allow for adequate planning. There was no backlog, and the numbers Bonitas referred to were normal business volumes, it said.
“If the new providers were not adequately capacitated to handle known volumes, that is a matter between them and Bonitas. Medscheme has fulfilled all [its agreed] obligations,” it said.
Momentum Health chief marketing officer Damian McHugh said switching a scheme of Bonitas’ size from one administrator to another is a huge undertaking, and “teething problems” are to be expected. Momentum Health has 18 client schemes, including Bonitas, covering a total of 3.96-million lives.
He acknowledged the anxiety caused by unresolved queries and emphasised that staff are working hard to minimise the impact of the transition on Bonitas members.
Medscheme, which was Bonitas’ administrator for 43 years, took legal action against the scheme over its decision to change service providers last year. It has asked the court to interdict Bonitas from implementing its contracts with Momentum Health and PHA pending the outcome of a forensic investigation by the Council for Medical Schemes (CMS) into an administration contract Bonitas previously awarded PHA for its low-income option Boncap.
CMS, the industry regulator, has encouraged schemes to review long-standing administration contracts. In a recent industry circular, it expressed concern about the risks of “evergreen” deals. It said such contracts might not be regularly assessed to ensure they offered value for money, weakened scheme governance because administrators might have undue influence over the board of trustees and potentially restricted new market entrants.
CMS spokesperson Stephen Monamodi said the regulator does not have a view on the situation at Bonitas, as it does not know the extent, nature or cause of the problems. “We have reached out to Bonitas to obtain the details,” he said.
In general, moving administrators should not affect member cover if the former administrator handed over all the information required and the new administrator onboarding was performed meticulously, in line with the law and the administration contract, he said.
Correction: June 5 2026
An earlier headline for this story incorrectly said Bonitas blamed momentum for the backlog.
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