Affinity Health pays for nothing

Only responses we have received from Affinity was declines on Authorizations. Apart from that NO ONE has contacted us with regards to anything stated above. The only investigation that was done was to see if the Hysterectomy will be paid for which like everything else has been declined early January. This as stated by the lady that contacted my wife, we knew about the Fibroids. According to my knowledge Fibroids can only be seen when a scan is done. That would be the radiology scan we had to pay for last year because Affinity did not want to pay for it.

Unfortunately they cannot remove the fibroids without a Hysterectomy. But as mention even tho we have a medical aid we still need to pay for doctors, medicine, radiologists and pathologist cash where in the policy statement you are referring to it says that you would be paying for it. In the referred policy statement we are allowed to use Doctors outside the network of which you will pay part of the payment (As per the policy). Thus far we had to settle the doctors (Even the one at the Hospital) in full. Note this is the Hospital you sent us too. In addition there is 1 month waiting period on pathology and radiology in the above mentioned policy document and the pathologist and radiologist was based at the hospital you sent us too, were we had to pay cash since approval was declined / refused and we are with you longer than one month. Please note that we have been reading the above mentioned policy as per your request even before all of this, but yet we are still paying cash for our medical expenses because all claims to you are declined or not approved. We even tried your pre-approval system and approval was not granted to go see a GP. We were however told that we can pay cash for the consultation and submit the claim and after investigation you will determine if you will refund the consultation fees or not. You are correct in saying that we require approval for a hysterectomy and as mentioned, that is to remove the Fibroids. The Hysterectomy is not just requested because we feel it's time but is requested by a doctor at a hospital you referred us to, to be able to remove the fibroids. Thus far the only approval we have received from you for any medical expenses was for the casualty. Doctors, medicines, pathologists, radiologists etc are all being refused, yet in your policy you state they it would be paid for. If Dalview Hospital (LIFE) is on your network, which I assume it is since you said we should go there in case of an emergency, why did we have to pay for the doctor, the pathologist and radiologist and medicines. If they are not on the network why were we sent there in the first place? What is written in your Policy statement and what is happening in actuality are two different things. I have also compared the Policy statement with your website to see if there might be a difference between then and now, and everything in the policy seems to be the same on both your website and the printed policy statement, yet we are paying for our medical expenses out of our own pockets because everything else that we were told in the policy will be covered by you get declined. That being doctors, radiologists, pathologist, medicine and in this case an operation to remove fibroids and you are now refusing the claim because of the word Hysterectomy. I am sure if it was possible to remove the Fibroids without the Hysterectomy ,the doctor (that we paid for), would have suggested it as an alternative solution.