Urgent Escalation: Inadequate Medical Procedure Authorisation – Cecilia M.M. Nel | Policy ***

To Whom It May Concern,

I am writing to escalate a serious issue regarding the insufficient cover authorised for a medically necessary surgical procedure scheduled for 16 July 2025, under my Affinity Combined Plan (Policy No. ***).

The total cost of the procedure is R77,013.81, yet only R22,000.00 has been approved – resulting in an unaffordable shortfall of over R55,000. This is despite:

Clear medical motivation and ICD10/procedure codes submitted

The urgent nature of the case: chronic pelvic pain, haematometra, and previous endometriosis diagnosis

Verbal confirmation received from your team during calls on 16 and 30 January 2025, stating that cover would exceed R100,000 – which can be confirmed on your call recordings

Based on these documented benefits, I respectfully request a full and urgent review of this authorisation. It is unreasonable for me to be left with a R55,000+ shortfall for an approved and medically necessary procedure – especially when the information given to me by your own consultants indicated significantly higher coverage.

I am urgently awaiting your response and adjustment of the authorised amount in full alignment with policy benefits and verbal confirmations provided.

Kind regards, Mrs. Cecilia Maria Margaretha Nel