Disgusting service from your Forensic department regarding a complaint about a doctor.

I submitted a complaint about a doctor submitting claims to Affinity for procedures I paid in cash, as I see this as ***** and thought I was being a good person reporting this so my medical aid does not pay for something I already paid for. Upon investigation it seems like the doctor also reported incorrect ICD 10 codes and incorrect blood work codes.

The initial consultant I dealt with, Anche (whom I have left reviews about previously as she is very helpful), was very understanding, sympathetic and made me feel like my complaint was being taken seriously. I mean, reporting incorrect ICD10 codes is *****….

Unfortunately, this experience turned into an absolute nightmare. Where I thought I was doing the right thing in reporting a doctor who submits invalid claims and ICD 10 codes, I was made out to be exaggerating and over reacting and not understanding what I went in for. (Which does not even make sense, because why else would I be reporting it….. I would then not have known that something was wrong if I did not know what took place in the doctor’s office, I even sent them supporting documents of my blood test results and had the finance department from the doctor confirm that they in fact did put the incorrect ICD0 codes and incorrectly billed my medical aid.) Romaana from your forensic department has absolutely no customer skills. She is condescending and just plain rude. She made it out like I completely did not know what was happening during my consultation and that it was my fault that the doctor put the incorrect ICD 10 codes. She was in full defence of the doctor but also admitted that he was incorrect for submitting the incorrect ICD10 codes. Her disgusting attitude left me furious and seriously considering cancelling my policy.

This whole incident has left me feeling disappointed in Affinity’s service, as I am a paying customer who just wanted to do the right thing. But if this happens in the future, I don’t think I will take on the stress and humiliation that comes with reporting it again. If Affinity treats a good act with such a disgusting response, I might even consider another medical insurance.