1 reviews | Active since Jul 2020
Rude awakening
I became a member of Affinity health on 2015/11/01. I chose the Affinity Health combined plan which means that I had the Day to Day benefits and Hospital Plan. After almost 3 years on 2018/08/30 I had severe abdominal pain and my wife took me to Arwyp Private Hospital at 5am in the morning. It was clearly an emergency. This was the first time I needed my health cover. The doctor on duty in the emergency room requested a sonar scan and the request was immediately rejected by Affinity Health. I had to sign several forms to say that I will pay for the scan myself. Affinity refused to refund this amount on the grounds that they do not pay for admissions for purely diagnostic purposes. This action defeats the purpose of Health cover. The final diagnosis and conformed treatment indicated an Appendicectomy. Affinity Health authorised R30 000 according to the applicable stated limit for this common procedure. The estimated shortfall was R119 309.62. I could not afford this amount and had no other alternative action suggestion by Affinity Health and ended up at Tembisa Hospital. I was so sick and did not anticipate this happening to me, who would think that there would be such a huge shortfall ? Is Affinity Health not aware of the cost of treatment ? Only at that moment I realized the predicament I was in. When you apply for health cover you are not made aware of these shortfalls. I joined under the impression that should I need help this would be taken care of by Healthcare professionals in private Hospitals. I did not expect that a Health cover provider can offer for you to go to a state Hospital. What is the point then of paying for Health cover? This event can be confirmed and I will on a daily basis review one of a trail of events leading up to the cancellation date of my health cover with Affinity Health after a period of 4 years during which time my contribution was paid on time every month.
We are sorry to hear that the policy you had did not meet your medical needs.
Please note that the costing of treatment is unknown to Affinity Health as treatment differs according to the condition and we are made aware of the costing when relevant documentation and authorisation requests are received from members. All your concerns raised were addressed and detailed communication was provided to you.
We do understand the seriousness of your condition and it is unfortunate that we cannot assist a former member with treatment post cancellation.
Kind Regards
Affinity Health Management Team
We are sorry to hear that the policy you had did not meet your medical needs.
Please note that the costing of treatment is unknown to Affinity Health as treatment differs according to the condition and we are made aware of the costing when relevant documentation and authorisation requests are received from members. All your concerns raised were addressed and detailed communication was provided to you.
We do understand the seriousness of your condition and it is unfortunate that we cannot assist a former member with treatment post cancellation.
Kind Regards
Affinity Health Management Team
Thank you for your reply.
Surely as professionals in your field you should know how much every treatment for any condition costs, how can you insure someone when you do not know how much it will cost ?
or at the very least have a ballpark figure? You should be in a position where you can advise your members on where they can actually go where the insured amount will actually cover the costs. I want to be very clear when it comes to my concerns being raised: I was never asked to raise my concerns by you. The part that you are aware of or the events that you can confirm are what you know from your side only, I was never consulted. Once you knew I had to go for a mandatory biopsy requested on 2019/04/12 for a condition that was likely to be Lymphoma (Cancer) you should have advised me on how to get this biopsy done and diagnosed as soon as possible and not offer me R10 000 for a R60 000 procedure from the daily illness benefit, (a biopsy of the intestines should not fall under the daily illness benefit) , and then just leave me to figure this out on my own. No one from Affinity ever phoned in 6 months to hear if I managed to get the biopsy done or if they could assist. This is how I ended up at Steve Biko Hospital, I did not make a decision to go there, I was left with no other option. I went for every appointment I could get and six months later I still did not not have a diagnosis. The detailed communication that you provided me with was bias and much too late. That communication does not begin to cover all my concerns.
It is obvious that you can not give treatment to former members, that would be stupid, but it is unfortunate that you did not assist me to get a biopsy done on time, well within my membership period then you could have provided me with the treatment I needed also well within my membership period and the Lymphoma would have progressed less.
Kind regards
Vernon Viljoen.
Thank you for your reply.
Surely as professionals in your field you should know how much every treatment for any condition costs, how can you insure someone when you do not know how much it will cost ?
or at the very least have a ballpark figure? You should be in a position where you can advise your members on where they can actually go where the insured amount will actually cover the costs. I want to be very clear when it comes to my concerns being raised: I was never asked to raise my concerns by you. The part that you are aware of or the events that you can confirm are what you know from your side only, I was never consulted. Once you knew I had to go for a mandatory biopsy requested on 2019/04/12 for a condition that was likely to be Lymphoma (Cancer) you should have advised me on how to get this biopsy done and diagnosed as soon as possible and not offer me R10 000 for a R60 000 procedure from the daily illness benefit, (a biopsy of the intestines should not fall under the daily illness benefit) , and then just leave me to figure this out on my own. No one from Affinity ever phoned in 6 months to hear if I managed to get the biopsy done or if they could assist. This is how I ended up at Steve Biko Hospital, I did not make a decision to go there, I was left with no other option. I went for every appointment I could get and six months later I still did not not have a diagnosis. The detailed communication that you provided me with was bias and much too late. That communication does not begin to cover all my concerns.
It is obvious that you can not give treatment to former members, that would be stupid, but it is unfortunate that you did not assist me to get a biopsy done on time, well within my membership period then you could have provided me with the treatment I needed also well within my membership period and the Lymphoma would have progressed less.
Kind regards
Vernon Viljoen.