1 reviews | Active since Apr 2011
Claim not processed and no response
<p>I am very disappointed with the service I have received from Affinity Health. Affinity has failed to pay out a claim I submitted on 03 October 2016. I submitted a claim with all the relevant documents for a claim for a consultation fee in the amount of R450.00 - I got an instant reply confirming they had received my documents and the claim would take up to 30 days. It is now 04 December 2016, exactly 2 months since I put in the claim and still no response or feedback. I have e-mailed Carla Botha (She never rep**** to my e-mail and Kim Anderson who always rep**** with an "I will follow up shortly" I was very ill on the 30th September late in the evening. I contacted the Affinity Emercency line and explained that my GPs are closed and I am in a lot of pain. They guy (think Bobby) advised that I can go to any hospital that is open close to me. I told him the nearest hospital to me was in Montana, He then contacted Netcare and called me back advising that I can go and just pay the consultation fee if I don't get admitted then I should just claim it back. To date I have not received the payment back. Very disappointing, indeed.</p>
Good day Alzone,
Thank you for taking the time to speak to our Complaints Officer.
As discussed, the refund was paid directly to the provider on 21-11-16. In reference to any other outstanding claims; please email them directly to the Complaints Officer and we will look into them for you.
Kind Regards,
Affinity Health Management Team
Good day Alzone,
Thank you for taking the time to speak to our Complaints Officer.
As discussed, the refund was paid directly to the provider on 21-11-16. In reference to any other outstanding claims; please email them directly to the Complaints Officer and we will look into them for you.
Kind Regards,
Affinity Health Management Team
Hi Sanchia
The R456.19 that you allegedly paid was an additional amount and not the total amount.
So please advise why you are saying I should follow up with the hospital for the R450.00?
Based on the Account Statement in my e-mail the total amount was R906.19 and I had paid the hospital the consultation fee in the amount of R450.00 you then had to pay them the balance of R456.19 and you had to reimburse me my R450.00 that I have been asking about for two months now!
Your prompt feedback in this regard will be highly appreciated!
Hi Sanchia
The R456.19 that you allegedly paid was an additional amount and not the total amount.
So please advise why you are saying I should follow up with the hospital for the R450.00?
Based on the Account Statement in my e-mail the total amount was R906.19 and I had paid the hospital the consultation fee in the amount of R450.00 you then had to pay them the balance of R456.19 and you had to reimburse me my R450.00 that I have been asking about for two months now!
Your prompt feedback in this regard will be highly appreciated!
Good day Alzone,
Attempts to contact you telephonically have proved unsuccessful, please advise on an appropriate time for the Complaints Officer to phone you.
Please note that an email requesting the outstanding accounts has been sent to you in the meantime.
We look forward to your feedback.
Kind Regards,
Affinity Health Management Team
Good day Alzone,
Attempts to contact you telephonically have proved unsuccessful, please advise on an appropriate time for the Complaints Officer to phone you.
Please note that an email requesting the outstanding accounts has been sent to you in the meantime.
We look forward to your feedback.
Kind Regards,
Affinity Health Management Team
The e-mail you just sent me indicates that you want proof? I have submitted the statement to you and forwarded all my previous e-mails sent to Carla/Kim. All you can reply to is that I need to send you proof. I sent you a detailed statement from MED24 that clearly shows my credit card payment in the amount of R450.00 as well as the slip that I received after paying that amount. You reiterate that you paid the provider R456.19! If my total account was R906.19 who then paid the R450.00? Your first call to me this morning indicated that you paid the service provider and I need to ask them to reimburse me? Why haven't your service department informed me about this 2 months ago? You should stop communicating with me on Hellopeter if you want to e-mail me with irrelevant information. Your services totally suck and the complaints officer you assigned to me is beyond clueless. Please contact me once you can ask me for my banking details to reimburse me. Other that that refrain from your "polite" responses on Hellopeter until you have resolved my query.
The e-mail you just sent me indicates that you want proof? I have submitted the statement to you and forwarded all my previous e-mails sent to Carla/Kim. All you can reply to is that I need to send you proof. I sent you a detailed statement from MED24 that clearly shows my credit card payment in the amount of R450.00 as well as the slip that I received after paying that amount. You reiterate that you paid the provider R456.19! If my total account was R906.19 who then paid the R450.00? Your first call to me this morning indicated that you paid the service provider and I need to ask them to reimburse me? Why haven't your service department informed me about this 2 months ago? You should stop communicating with me on Hellopeter if you want to e-mail me with irrelevant information. Your services totally suck and the complaints officer you assigned to me is beyond clueless. Please contact me once you can ask me for my banking details to reimburse me. Other that that refrain from your "polite" responses on Hellopeter until you have resolved my query.
Good day Alzone,
Thank you for your patience whilst we conducted this investigation.
Please note that the requested hospital account has been reviewed by the Claims Department and an urgent reimbur*****t request has been sent through for processing.
Kind Regards
Affinity Health Management Team
Good day Alzone,
Thank you for your patience whilst we conducted this investigation.
Please note that the requested hospital account has been reviewed by the Claims Department and an urgent reimbur*****t request has been sent through for processing.
Kind Regards
Affinity Health Management Team