1 reviews | Active since Apr 2017

31 Jul 2019, 12:49

Wish i could rate 0 stars

Where to start when you have a million issues with the service. My wisdom teeth started cutting (which hurts like hell) and happens to everyone around my age (22), so then obviously I went to the dentist for it to be removed and he then told me that it would need to be surgically removed under general anesthesia.

Great, went and got a motivation letter from the surgeon where he stated that the teeth needs to be removed as it would lead to chronic pericoronitis (basically inflammation of my gums due to the teeth cutting through it) if the teeth are not removed , understandable right?

NOOOOOOOO, the claim got declined on the premise of it being a "cronic" thing? I called and explained to them that they are not understanding it correctly (as the letter was in afrikaans) it is not YET cronic and that's why it needs to be removed, for us to prevent me getting a cronic problem? I also attached another letter from the surgeon explaining this, understandable right?

NOOOOOOOO, this time it gets declined on the premise that it is a "pre existing condition" MY WISDOM TEETH CUTTING THROUGH MY GUMS?! it doesn't take a rocket scientist to see how this is absolute madness.

I go BACK to the surgeon , pay for the consultation just to get him to type a custom new letter (as the previous ones was standard letters he submits to all medical aids/insurances) yet Affinity has problems understanding it.

He types a new letter basically spelling it out for them like he is speaking to 12 year olds instead of a medical board that this IS NOT A CRONIC NOR A PRE EXISTING CONDITION AND THEY HAVE NO GROUNDS TO DECLINE THIS CLAIM. All this after they accuse him of changing the letter solely for me to get authorization even though they were the ones that had trouble understanding the previous letter, he never changed his medical opinion, only the wording of it to try to ensure that it is understood.

frustrated yet?

They decline the claim ONCE again and say that it remains declined (not even stating a reason this time as I think they may be running out of excuses as to why they do not want to help their client)

This morning I talk with one of the complaints department employees and she tells me that the new custom letter is being read as we speak (yet they already declined the claim yesterday so they declined without reading the motivation letter) she tells me all of this with her very rude, impatient and unprofessional tone of voice as if she is the one with painful wisdom teeth that has been paying Affinity every month just to find out that a car with no wheels nor steering wheel would be more useful than this pathetic scheme.

SIES MAN! IF YOU DO NOT WANT TO HELP YOUR CLIENTS THEN SHUT YOUR DAMN DOORS!!!!!!

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Replies (7)
Affinity Health
Affinity Health's reply31 Jul 2019, 13:06
Official
Good day Andrea

We confirm that your case has been submitted for clinical review.

It is important to take note that all advice provided to you is, and will be, based on the documentation received from medical practitioners.

Kindly await feedback from the Complaints Department soon.

Your patience would be greatly appreciated.

Kind regards
Affinity Health Management Team 
's update31 Jul 2019, 14:00
Reviewer Update
submitted for clinical review now, yet you already declined yesterday? I'll wait for your feedback
Affinity Health
Affinity Health's reply31 Jul 2019, 14:30
Official
Kindly note that the decline yesterday was before new correspondence received from you today.

Remember, the documents have been doctored a number of times, and it is important to reach the truth of the diagnosis in order for the final feedback provided to be of quality service.

Your patience throughout the investigation is greatly appreciated.

Kind regards
Affinity Health Management Team 
's update31 Jul 2019, 16:26
Reviewer Update
Please tie up who is responsible for not doing their job as everything regarding my claim was submitted (including the custom letter from the surgeon) as mentioned above earlier this week and yesterday you declined it. This tells me no one even properly read through all my documentation!
Affinity Health
Affinity Health's reply31 Jul 2019, 16:31
Official
Good day Andrea

Kindly await feedback from the clinical assessment soon.

Kind regards
Affinity Health Management Team 
's update31 Jul 2019, 16:33
Reviewer Update
The documents have not been "doctored" the semantics and wording thereof had to be changed ON YOUR DEMAND as the previous letters caused confusion for you eventhough it was a standard letter that they provide to ALL the medical aids/insurances
's update20 Aug 2019, 11:00
Reviewer Update
Update: The claim has been approved after further clinical review they confirmed that this is not pre existing and therefore they will honour my claim. Tebogo was very helpful even after we got off on a very bad foot.