AFFINITY - They DO NOT care !!

An update on our situation with Affinity :

Great, because your online services is not of use at all, not even to talk about the telephone services.

My child was supposed to be admitted on Monday …

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From: Vanessa ********** Sent: Friday, May 18, 2018 2:15 PM To: Heili Lane ********** Cc: ********** 'Morne Lane' ********** Subject: Re: COMPLAINT - MJ LANE ********** 062

Good Day, Thank you for your email, your complaint has been received and is being evaluated. You will be contacted with feedback soon. Regards.

Manage

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Heili Lane

Heili Lane 17 May 2018

By e-mail Member : Mr Morne Juan Lane- **********

Dear Mr Morne Juan Lane

RE: ********** 062/ Jaden Vorster Dep02/Ganglion of the middle finger Claim Date:17 May 2018

We have received your request for benefit confirmation on the above claim and have assessed this in line with the policy terms. After consideration and examination of supporting information submitted to date, we unfortunately must advise that this claim incident does not qualify for cover.

Claim validity assessment is done based on the policy terms and using the International Classification of Diseases coding (ICD-10). This is a diagnostic coding standard that was adopted by the South African National Department of Health in 1996. The reason for the repudiation of the claim is outlined in the policy terms, which reads as follows: The reason for the repudiation of the claim is outlined in the policy terms, which reads as follows for the (2) reasons for this decline: 1st-Reason is that there is no authorization for pre-existing condition 2nd-Reason is that there is no authorization for day procedure 2. DEFINITIONS 2.36 "Pre-Existing Condition" means any Bodily Injury, Illness, Dread Disease, signs or symptoms whether existing or diagnosed that: - The Insured Person sought or received medical advice, treatment, hospitalisation or monitoring for before the Benefit Start Date; -The Insured Person could reasonably have been expected to have sought or received medical advice, treatment, and hospitalisation or monitoring for before the Benefit Start Date; - The references in this definition to advice, treatment or monitoring include conventional or alternative advice, treatment or monitoring. SECOND REASON IS DUE TO DAY PROCEDURES 2.14 "Day Procedure" means surgical procedures that can be performed in a single day without the need to admit the patient for an overnight stay in Hospital. For example, colonoscopy, endoscopy, tonsillectomy, etc. Signs & Symptoms of the condition started presenting within your 90 day waiting period as such, we are regrettably unable to provide any benefit for this claim. Claims for treatment related to pre-existing conditions will only be considered after the exclusion period of 24-months has passed. We are therefore regrettably unable to provide any benefit for this claim. You are at liberty to appeal our decision to not consider this claim within 90 (ninety) days of receipt of this notification. Should you wish to appeal our decision, you must do so in writing and outline your detailed reasons for the appeal. Your appeal will be investigated by Management, who will provide you with a written response within 30 (thirty) days of receipt. Kindly submit all correspondence and supporting documentation to Affinity Health (Pty) Ltd, Postnet Suite 124, Private Bag X101, Farrarmere, Benoni, 1518. You may also submit the documentation by e-mail to ********** Sincerely, Brave Nyirenda Kyle van Vuuren Hospital Pre-Authorisation Department Co-Checked & Signe

Manage

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Heili Lane

Heili Lane My response hierop was: en ASSEBLIEF AS ENIGE IEMAND DINK EK IS ONREDELIK laat weet my.....

Manage

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Heili Lane

Heili Lane I received this email and do NOT AGREE with your response hereto.

Would have rather we didn’t take him to the doctor ???? There were NO indication that this would turn out to be your so-called “pre-existing” condition.

Your reasoning are inhuman and unacceptable and this matter will be handed to the Ombudsman.

Your policy with regards to day-day procedures ….. The doctors specific words were he MIGHT BE able to do a same day procedure but without any guarantee. Jaden is a mere ten years old , how and who are you to predict that it would be a same day procedure ? Again , would you rather this procedure not be done and he bares the consequences for the rest of his life WHILST you were more than willing to deduct the premium every month ??

Affordable Health for Everyone is a logo you should definitely reconsider because you do not in the least care about anyone.

Please take note that this matter will be taken up to your superiors. In the meantime we await your response.

Heili Lane