JP
Joyce P

1 reviews | Active since Dec 2016

07 Jul 2019, 20:17

Bad Service

On the 25/06/2019 I visited my Orthopedic Surgeon, he then ask me to request an authorization from Affinity Health for a surgery that is needed to be performed on the 17/07/2019. Firstly they refused to pay for an MRI then they asked for documents for the surgery to be performed. On the 27/06 I sent the documents then I received an email from Sherain Bent requesting a quotation from the Dr and the hospital the procedure will take place. I sent all the documents when I called to check how far they are with my request I spoke to Buhle who said they don’t have the quotes from the hospital and the Dr’s. He then ask me not to send them, because I explained to him that I didn’t send them once but three times. He said I must give him the amounts and Dr’s names and PR numbers. He said he will speak to his supervisor they will send the authorization before the end of the day. He didn’t come back to me and the next day I received a call from a gentleman who said I just joined the company on the 01/07/2019 therefore I don’t qualify because of the waiting period, he actually called on my house landline not my cell. I joined Affinity Health in 2018 so I didn’t understand what **** he was telling me. If that’s how the run business at this company I totally made a big mistake by joining them. I demand that they sort this out because I’m not letting them getaway with this, if they did this to someone they need to be stopped.

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Replies (4)
JP
Joyce P's update08 Jul 2019, 20:17
Reviewer Update
Then they went and found my old reports and claim that the injury that occurred recently is an existing one. They conclude that then rejects my claim, they are not even doctors Lebo and Sherain, they think I have time to play. I’m not coping with this growth on my knee the pain and the swelling. My beautiful leg is now having a deformed shape because of this recent injury. The fact that I took an insurance it’s for that to protect me not for them to go and look for loop holes just because they want to save money and be praised that they are good employees they reached their target on my behalf. No Affinity people man up and do the right thing.
Affinity Health
Affinity Health's reply09 Jul 2019, 09:53
Official
Good day Joyce

We appreciate you raising your concerns with us.

We confirm that a Complaints Officer has been in contact with you to advise that the clinical assessment of the medical document provided is being investigated, and that feedback will be provided to you soon.

Kind regards
Affinity Health Management Team 
JP
Joyce P's update09 Jul 2019, 19:28
Reviewer Update
There is nothing that Affinity is doing but to insult me. Today Tebogo called me saying she is responding regarding this matter on Hellopeter that they will resolve this matter. Later on the same Lebogang whom said to me they declined my request yesterday, she is now saying they agreed to pay R 10 000 towards my surgery as a day to day payment. My plan is not day to day but a hospital plan they need to pay the full amount requested for the hospital cost. That’s all I’m asking from them and they are waisting time cause the hospital is waiting to confirm my date and I need to inform my employer. I asked Lebogang to send me a confirmation letter about what they want to pay, I’ll take it to my lawyer. She never came back to me. This is the third week that we are busy with the same thing. This is the worst service provider I have ever come across.

Affinity Health
Affinity Health's reply10 Jul 2019, 08:05
Official
Good day Joyce

Please note that your procedure requires admission for under 24 hours.

Such an admission is deemed a day procedure under the Hospital Benefits in the Affinity Health policy.

Therefore, the applicable benefit for your admission is R10 000 for 1 day from the Daily Illness Hospitalisation Benefit, as per your Hospital Plan.

Please note that Pre-Authorisation and the Complaints Officer assisting you will revert back to you with feedback to help you understand your benefits soon.

Your patience is greatly appreciated.

Kind regards
Affinity Health Management Team