Disgusted

I am so disappointed and angry with Affinity Health. In December I called for Authorization to see a Dr about a suspicious mole. I was advised to rather go to my GP and not a specialist. We discussed the whole process, that I must give them my authorization number and the procedure in the rooms will be paid for. Being a nursing sister myself, I knew the consequences of this procedure and that it will go to the Lab for testing and we discussed the whole process. I had the procedure, gave my authorization numbers to Dr's and filled it in on the Lab form and left. A few days later I got the shocking news that it was indeed a Melanoma and I then needed to see a surgeon as I needed surgery. Again all the Authorizations and Quotes were done and approved. I agreed and paid my excesses that were over the claim amount for this procedure and everything seemed good. Now in January I start getting accounts from Labs. Affinity has not paid them a cent for all the testing, amounting to just over R10,000-00. When I called to query this, I was told that they are not paying as I never got Authorization for this, the authorization I got was only for the procedures and I should have ASKED about the Lab costs. I am absolutely disgusted! I was told that they do not work on assumptions when I said that obviously the procedure had to end with Lab tests. I was not informed once that I needed extra authorizations for lab costs,, and how ridiculous that it is not done at the same time as your initial calls (Effectively saying that straight after undergoing a painful procedure, you must now phone Affinity again, when you spoke to them a mere 2 hours prior to the Dr's visit and were not informed of this requirement). When I visit my Dr annually she sends me to the lab for routine bloods, and this is covered, without any phone calls and authorizations, so why would I expect this to have been any different?

I am very seriously looking at other options for my family for Medical cover, the costs and time wasting run-around from Affinity is not justified in my opinion.