Affinity health avoiding paying claims
We have medical insurance with Affinity health. My husband was admitted in hospital for an appendix operation, they approved the admission and they procedure was done. Five days later he suffered a terrible fever and excruciating pain, we went back to the same hospital casualty. The surgeon recommended readmission for further observation which they declined due to the fact that only R30 000 rands is allocated for the procedure. The re admission was for complications relating to the procedure which there is no clause on their medical insurance for exclusion thereof. The Dr said he will see the parient at casualty, I was told they declined the casualty consultation because they have not reveived the previous account. I then called them for clarity, they explained that there is only an amount per year allocated so they cant approve prior receiving the previous account. As I was enquiring further the consultants switched from a Juanita who asked me if I understood english to a very rude team leader Bongiwe Zulu who did not even introduce herself to me. She kept on raising his voice on the phone and refused to give a straight answer on whether they will cover casualty fees or not. The hospital staff explained to them that there were no casualty fees charged on the previous visit because the patient was referred from medicross which is their preferred service provider straight to a surgeon who will charge from his rooms.  They told them that they are certain that no casualty fees will be charged for the previous visit but still Bongiwe Zulu refused to give a straight casualty approval. I further asked direct questions regarding the casualty benefits of my husband she still refused to respond pending outcomes of casualty treatment. She continued avoiding to respond till I had to attend to the Dr treating my husband. Affinity health always avoids paying and this is the second time in our family. I had the same encounter where I waited for four hours at casualty because they were refusing to give a preauthorisation number. From a bill of R43000 for 3 days they only paid R23000 and we had to pay R20000. This is fraud not medical insurance, stay away from itm