"The prostate is a part of the male reproductive system and is not covered by Affinity Health"

I have been with Affinity Health for several years and rarely make use of the services. Only ever going in when the pain becomes unbearable or an annual checkup.

Requesting their formulary to see what is covered, is not possible and they have stated that it is provided to the Doctor, that the Doctor will know what is covered and advise me accordingly. This seems contradictory, as I was told by the Doctor that it is "definitely covered" as a basic annual checkup. Further checks and queries at Hamadi Pathologists also confirmed the tests as fully covered. They even called their representative to confirm cover. In trying to obtain authorisation from Affinity Health, one of the tests ( a PSA ) did not have a code and the Affinity Health agent was unable to provide assistance as to what a PSA code would be and if it would be covered. I am not in the habit of performing tests that are not covered due to my financial situation, I chose to believe the Doctor and Hamadi Pathologists ( the only ones able to access the formulary ) confirming the test as covered by Affinity Health.

A month later a remittance ( with incorrect amounts and cover ) was provided stating that I owe a considerable amount. I queried it according to what the Affinity Health Agent on Whatsapp stated I was covered for and was told that the remittance is correct. Upon a second review, screen shots of the remittance and the Whatsapps noting the stated covered amounts, it was corrected and I was told that I owe the provider nothing. Upon asking for proof thereof I was then told that the PSA is not covered. This leads me to believe that they are not treating customers fairly. The lack of access to the formulary, does not allow one to establish the costs involved and whether or not it is affordable. Requests for the code and amounts covered have been unreliable.

This series of events has caused me to question my sanity and whether or not to cancel my subscription.

My back and forth with Affinity Health regarding incorrect billing ( on remittance ) failure to provide codes ( which the Doctor and Hamadi state are fully covered by Affinity Health ) and to add ************** based on the fact that I am a biological male. Although it is somewhat embarrassing.

To quote the agent ( that didn't provide a name ): "The prostate is a part of the male reproductive system and is not covered by Affinity Health".

Followed by: "Kindly note that we understand your frustration , however the claim will not be paid. The member will be liable for the account. Prostate examinations are not covered on our plans. Any treatment regarding the reproductive system is not covered".

Strange how the doctor that has the formulary had a different opinion. I am dumbfounded.

Between the corrections that I had to point out, the endless frustrations endured, the quoted sentence was the fire that lit the fuse.

I am leaving this here whilst I attend to my duties and attempt to cool off. Hopefully other biological men see this and consider the implications.