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Andre N

1 reviews | Active since Jun 2023

02 Dec 2024, 15:42

Absolutely Appalling Service from Affinity Health - Would NOT Recommend this Medical Insurance to ANYONE!!!!

Dealing with Affinity Health has been an absolute nightmare. Over the past six months, we’ve had three separate cases where getting authorization for necessary medical procedures was a grueling battle. Every single time, they delayed, made excuses, and unfairly claimed conditions were "pre-existing." Here’s a breakdown of our horrific experience:

My Wife’s Medical Procedure Affinity Health outright declined authorization for my wife’s procedure, despite us providing a motivational letter from her gynecologist, Dr. PE Brune, who has been treating her since 2010. The letter clearly stated that her condition was not pre-existing. We appealed the decision, but they said it would take 14 days to review. Meanwhile, the doctor wanted to proceed immediately. Affinity still declined, claiming it was pre-existing—completely ignoring the medical evidence provided. This unnecessary delay and denial were not only frustrating but also detrimental to her health.

My 5-Year-Old Daughter’s Dental Procedure My daughter needed sedation for cavity repairs, as it’s too traumatic for a 5-year-old to undergo such procedures in a chair. Affinity dragged their feet for over a month before finally approving the sedation, only after we logged a complaint. Their reason? Once again, they claimed it was pre-existing. Cavities—pre-existing? How absurd is that! My daughter had to endure unnecessary delays because of their incompetence and lack of care.

My Son’s Hearing Issues After my son’s audiologist referred him to an ENT surgeon for further tests, we paid out of pocket for these consultations because we knew getting authorization from Affinity would be a nightmare. The ENT then requested a CT scan of his middle ear to determine the best treatment plan. Surprise, surprise—they refused authorization, again claiming it was pre-existing. Now, we have to jump through hoops to get a doctor to complete questionnaires and provide billing history to prove otherwise—all for a scan that is critical for diagnosing and treating our son.

Every interaction with Affinity Health is a fight. We have a combined family plan with them, but every time we need to see a doctor or get a procedure approved, it’s a bureaucratic mess filled with excuses and blatant disregard for urgency. Their “pre-existing condition” excuse is their go-to response, even when it makes absolutely no sense.

Affinity Health has proven time and time again that they do not care about their clients’ well-being. The stress and frustration they’ve caused our family are unacceptable. We’re actively looking to move to a more reliable medical aid provider because Affinity Health is simply not worth the hassle.

Save yourself the time, money, and stress. Do NOT use Affinity Health.

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Replies (2)
Affinity Health
Affinity Health's reply02 Dec 2024, 16:06
Official
Good day Andre,

Thank you for sharing your detailed feedback and for taking the time to outline the challenges you and your family have faced. We deeply regret the frustration and distress this experience has caused.

At Affinity Health, we strive to provide a seamless and supportive process for our clients. As a medical insurance, all benefits are subject to pre-authorization. Before approval, a thorough clinical assessment is conducted by our Clinical Review Team to determine coverage eligibility and the applicable benefit.

We genuinely value you as a client and regret that our processes have fallen short of your expectations. We will escalate this matter and engage directly with the Pre-Authorization Department to address your concerns promptly.

Thank you for giving us the opportunity to resolve this matter.

Kind Regards,
Affinity Health Management Team 
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Andre N's update02 Dec 2024, 16:32
Reviewer Update
Good day,

Thank you for your response. While I appreciate your acknowledgment of our frustration, it’s hard to see how your processes align with providing a “seamless and supportive” experience. This is not the first time we’ve encountered delays, denials, and unnecessary hurdles when seeking pre-authorization for essential medical procedures. Over the past six months, we’ve had to repeatedly escalate issues and lodge complaints just to get the care we are entitled to as paying clients.

Your reliance on “clinical assessments” as a justification for delays and denials does not explain why basic, necessary procedures—like dental sedation for a 5-year-old or a CT scan for a critical diagnosis—are treated as pre-existing conditions without due consideration of medical evidence. It’s alarming that my family has had to endure delays and financial burdens due to your team's failure to act promptly or fairly.

To make matters worse, my wife has still not received the procedure she urgently needs. Despite providing a motivational letter from her gynecologist, clearly stating her condition is not pre-existing, your Clinical Review Team continues to insist otherwise. This repeated misuse of the “pre-existing” label not only undermines your credibility but also demonstrates a lack of care for your clients’ well-being.
Escalating the matter to your Pre-Authorization Department after the fact is appreciated but does little to undo the stress and inconvenience your company has caused.

We’ve already paid out of pocket for procedures and consultations because waiting for authorization was simply not an option. Moving forward, I hope this escalation results in meaningful change, as your processes are clearly failing clients in urgent need of medical care.

Thank you,
Andre