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Siphokazi N

1 reviews | Active since Jan 2023

05 Jun 2025, 17:18

"Why I cancelled Affinity Health-Lack of transparency around shortfalls"

I have recently cancelled my health insurance with Affinity due to a frustrating experience with communication and transparency. A major issue that I was never informed about a shortfall payment related to all pathology services when referred by a network doctor. As a customer, I expect to be notified in advance if there are any additional costs that are not covered by my policy especially when the referral is made within the provider's own network. Unfortunately, this does not happen, and I always only found out much later when contacted by the pathology provider for payment of a portion of the bill that is not covered which left me misled, deceived and unsupported. The most upsetting part is the false sense of security. You take out medical insurance to protect yourself in times of need, especially emergencies. But what is the point of being covered if you only found out later that you are still liable for bills that were not disclosed? It is not only just about money but being able to make informed decision about your healthcare. If you are considering Affinity Health, please be extremely cautious and ask for everything in writing especially regarding what is covered when dealing with referrals and diagnosis tests. Do not just assume that "network provider" means full cover. Good communication is essential in insurance and this lack of clarity made it difficult to trust the service. I hope Affinity Health takes steps to improve how they inform clients about potential shortfalls and billing matters, because no one should be caught off guard during a health scare.

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Replies (2)
Affinity Health
Affinity Health's reply06 Jun 2025, 08:15
Official
Dear Siphokazi,

Thank you for taking the time to share your experience with us.

We are truly sorry to hear that your journey with Affinity Health did not meet your expectations. Your concerns regarding communication and transparency—particularly around pathology shortfalls and unexpected costs—are valid, and we regret the frustration this has caused you.

Please be assured that your feedback has been taken very seriously. We acknowledge that clear and timely communication is crucial, especially when it comes to healthcare-related expenses. While our policy documents and formulary guidelines do outline the cover limitations, we understand that this information should also be clearly reinforced at key touchpoints, particularly when members are referred for services such as pathology.

We fully appreciate how important it is to feel supported and informed, especially in times of medical need. Your experience highlights areas where we must improve, and we are actively working on strengthening how we communicate shortfalls and exclusions—both verbally and in writing—to ensure our members can make informed decisions about their healthcare.

We are sincerely sorry that we could not provide the level of reassurance and clarity you needed. Please know that your feedback has been shared with our management team, and will play a key role in shaping improvements to our service and communication protocols.

Thank you once again for bringing this to our attention. We wish you all the best going forward and hope to regain your trust in the future.

Warm regards,
Affinity Health Management Team
Affinity Health
Affinity Health's reply19 Jun 2025, 11:26
Official
Good day Siphokazi Ngxeke, 

We can confirm that several attempts were made to get in touch with you, but to no avail.

Kindly refer to the feedback provided on email by the Complaints Department. 
 
Warm Regards, 
Affinity Health Management Team.