Affinity health is a ****.

Firstly, they are not a medical aid. They will try to sell it to you that way intitially, and then whenever you try to claim, they will remind you that they are suddenly not a medical aid, but insurance.

I’ve been with them for a little over a year, and hardly get any claims paid for. Their reason, it’s not on the formulary list. The most mysterious list ever. Last year I tried since May to get medication paid for. Every prescription was rejected. Simple response, not on the formulary. No alternatives were offered either. In December I was fed up and demanded the formulary list be sent to me. After perusing this list, I found out that all of the medication prescribed to me was either covered under their formulary or an alternative was covered. Affinity blind sided me the entire year. This year, armed with this list, Ive had 90%of my medication covered. You have to fight for everything. This year they have been rejecting pathology and radiology claims left right and centre under the guise that it’s not on the formulary. They are refusing to send me this list. There is no actual proof that these procedures are no covered. Absolutely nothing in writing and nothing in my policy wording. Just an email or phone call form them saying it’s not covered. This seems sketchy. I do believe that they use this mysterious list as a way to reject everything.

They also have ‘trained’ staff to that can issue prescriptions and on two occasions prescribed the wrong medication and the wrong dosages. This was only found it at the pharmacy when trying to collect the meds. I find this utterly irresponsible. The one set of meds was for my 2 year old. How qualified are these people? They also want to rewrite the qualified doctors’s prescription, but the nurses at affinity have no idea how to prescribe medication. Often when they do, you have to wait up to 3 days to collect the meds. My son needed an antibiotic urgently. Affinity delayed us so much that he got progressively worse.

They also have the worst customer service. Each person you speak to is uninterested in the client and seeks to undermine you. They also use a very different policy document to the one that is sent to you. If you don’t know your document, you will just end up accepting their hogwash. I needed a Gastroscope and was referred to a section in the policy that says why it’s not paid for. The section referred was about rejected claims under workman’s compensation benefit. This had nothing to do with the procedure I needed. Suffice to say, after a sold two months of fighting and hundreds of rands spent on airtime, they approved the procedure. The catch: they only paid R800. I had to pay R1000. Yes, I paid more than them as part of my co payment. I was told that even if the procedure was R1000, I would still pay R1000 as a co payment. They clearly do not understand what the phrase co payment means.

Warning to anyone wanting to go with Affinity, please do not. There is so much more that I need to say about how terrible they are, but I sit. Have the energy or inclination. Affinity is terrible. Please do not sign up with them.