LS
Lindokuhle S

1 reviews | Active since Jan 2015

14 Jan 2019, 16:30

Affinity Health Claims Department- Poor Service

I have been with Affinity Health since 2016, their GP visit services have been great even the specialist cover but my problem now is communication with their claims department staff. I recently gave birth through a c-section in a government hospital because I couldn't afford the shortfall amount I had to pay the private hospital after affinity has covered me for the maternity benefit. I put in a claim for the first time on the 12th of December 2018 only to be answered now in January after I called non stop ( even though they said the claim would take 30 days when I called them 6 days after submission ) and was told that my documents were incorrect and will not suffice. I then asked what exactly was needed but no one is willing to tell me and to date I have been waiting for a response. I have already spoken to two different consultants and both left me hanging . I am not sure exactly what proof of birth do they need because I already submitted my full medical file from the hospital with doctors signatures, a claim form, my son's birth certificate as well as the discharge summary. January will mark the 2nd month without knowing if my claim will be paid out or not. They also told me that I should have called for pre authorisation but I am not sure how because it was an emergency and the person that took me to the hospital didn't know about it and everything happened so fast. The other thing is they also want me to look for the doctors that helped me give birth to complete the claim form and give a summary of my health before and after birth but the medical file I submitted already has the information of the 2 main doctors as well as a notes about my health and their signatures as well. I have already tried to get them to complete the form but they referred me to the Hospital's MVA office and that's where they made me pay for the medical file and said everything the insurance needs is there including the signatures.

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Replies (1)
Affinity Health
Affinity Health's reply14 Jan 2019, 19:16
Official
Good evening Lindokuhle

Thank you for raising your concerns with us.

We will investigate to the matter and contact you soon with feedback.

Please make sure in future that we are contacted on ***for pre-authorisation prior to being admitted in hospital.

Kind regards
Affinity Health Management Team