AS
Aschwyn S

1 reviews | Active since Jun 2013

24 Mar 2023, 19:33

Reason for decline: Pre-existing Condition Whilst Within The 12 Month Waiting Period

I have bee with Affinity Health since May 2022 - In the last year I have had a protruding lymph node on the left had side of my neck. I went to see my GP, and he suggested I go for a FNA, which was done and came out clear. I then went to see an ENT who is one of the best in S.A and he diagnosed it as a Bronchial Cyst and recommended that we cut it out. Reason being that there is a possibility that this could become malignant. I submitted quotes to the medical aid including a letter of motivation from the ENT specialist where he makes note of the above. I was due to go for the procedure on the 23-03-2023, but because the medical aid was awaiting docs this was cancelled for the 30-03-2023.When the medical aid first made contact with me, I was given the commitment that everything was going to be ok and that they will do their best to get this across the line.

Since the 23-03-2023 when speaking to the lady at Affinity I picked up that some of the questions and docs that they were requesting had no relevance to my procedure. I went on to say this to the consultant this morning on a call that was recorded. I could feel that they were looking for some reason to decline this procedure as they requested docs, such as previous bill history with my GP as well as when the FNA was done. I received a call at 17:58 today to tell me that the panel who reviewed the letter of motivation said that this cyst was pre-existent, and based on this they are not authorizing the procedure. At the time that this thing came about (a year or so ago), it was not said to be serious. It now is and I am a month away from being with the medical cover for a year - today was my 11th month payment. To say the least, this is ****ing disgusting and I will go to every radio station and every medical board to report this should this thing become malignant and I am in a life threatening position. I will go on to sue Affinity health and all its members for gross negligence and plain down ********* practice. As a business, Affinity's ethics suck, and I will make sure to spread their **** decisions all over social media.

0
Replies (2)
Affinity Health
Affinity Health's reply24 Mar 2023, 20:56
Official
Good Day Aschwyn, 
 
Thank you for raising your concerns with us. 
 
Please be advised that your complaint will be investigated and an outcome will be communicated to you in due course. 
 
Kind Regards 
Affinity Health Management Team 

Affinity Health
Affinity Health's reply24 Apr 2023, 15:39
Official
Good Day Aschwyn,
 
We can confirm that a Complaints Officer was in contact with you and provided you with feedback on the above raised concerns.
 
Should you require any further assistance please do not hesitate to contact us.
 
Best regards,
Affinity Health Management Team.