Affinity Health refuses to assist a patient that is critically ill

To Note: Affinity Insurance had my previous post on Hello Peter removed as they said I was not the main member: Below is my statement of the actual events and a warning to the general public.

Actual Case in Jeffreys Bay on Easter Friday 29 March 2026 : Before the 29th April, my sister had been to doctors when she was unable to urinate and had internal bleeding. The doctors gave her medication and inserted a catheter. Her catheter became blocked so I took her to Humansdorp Hospital around 8pm The hospital was very helpful and tried everything possible to have her admitted But Affinity refused to assist her because there was no Doctors letter. The bleeding continued and on Easter Friday I called in for emergency assistance. I was refused help for at least 20 – 30 minutes because we had no doctor available in Jeffreys Bay on Easter Friday to give her a referral letter. No matter how many times, I tried to explain to Affinity that we had no Doctors available and the closest hospital was 80km away in Port Elizabeth they just repeated the same thing. “WE cannot assist unless you have a Doctors referral." By this stage, my sister had huge clots of blood been discharged. After a lot of arguing, I eventually sent them a WhatsApp photo of the blood clots and they agreed to send an ambulance. But then they continued to state not once but numerous times in what,I deem to be a threatening manner “Be aware you will be liable for the ambulance fee if it is not an emergency” My sister was admitted to hospital and requires an urgent kidney removal. Needless to say Affinity will only pay R160 000 of the R500 – R800 000 required

Affinity Members need to be aware: Affinity staff are not interested in assisting and cannot comprehend simple statements like “there is no doctor available to assist and we live nearly 100km from the closest hospital” If they decide to assist you: You have to be sure you are dying as you will be told numerous times over “you will be liable for the account” I believe the amount they cover is a very clever trick – they know they are paying 1 / 10th of the fee required to perform the surgery they promise to cover. They know that most people on Affinity cannot afford expensive medical aid and believe they will be covered by paying the Affinity premiums.

I wonder how many cases Affinity pays for and how many like my sister, the patient has to leave the hospital in a critical condition, after paying their premiums for many years? So in my sister's case, she had to find between R500 000 to R700 000 for the operation with Affinity offering R160 000 minus the costs already incurred. My sister is currently at home suffering as she cannot get any help in South Africa. The state hospitals have not renewed the specialist doctors' contracts.

My questions to Affinity are: • Why does Affinity take payments from people living in areas where there are no Doctors available to assist them? • Why when I took my sister to the Humansdorp hospital at night for assistance she was turned away when the policy states: IMMEDIATE EMERGENCY CASUALTY ROOM TREATMENT.