Affinity Health Plan

I just discovered that Affinity only pays for one covid-19 test. For reasons I hope I don't have to explain, this flies in the face of public safety concerns. Testing is a crucial part of public safety at this time, and Affinity's refusal to cover all testing necessary for free is inhumane

Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because: Affinity Health Plan cancelled my insurance through the NY State of Health There is no record of me having gotten my Affinity Plan through the Marketplace (even though it was purchased there) because of the initial cancellation of my plan by AffinityThe NY State of Health requires a new confirmation number to reinstate health plansSince Affinity reinstated me directly and not through the Marketplace, Affinity is responsible for the delivery of my tax forms I have been in contact with the NY State of Health several times and asked them for tax forms They have no record of my insurance through Affinity and therefore have no forms for meUnless Affinity directly contacts the NY State of Health and updates my information on this issue, my tax forms need to come from Affinity In order for the Revdex.com to appropriately process your response, you MUST answer the question above Sincerely, [redacted] ***

While requesting for pre-auth for procedures, the calls for Affinity Health Plan ###-###-#### were all transferred to call center for messagesAfter multiple calls and long waits, phone calls were all answered by representatives, where calls are DISCONNECTED, multiple timesPre-auth was started on 0716, upon calling on and 0816, reps defends by saying they need weeks for processing pre-authsNo nurse managers were available to assist on expedited casesThree phones were transferred to care managers were they were unavailable to speak, with only voice mails for messagesThis is great inconvenience for patients and providersThis is not the correct way to provide care for any patients

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me and the matter has been resolved Sincerely, [redacted]

This is the most inefficient insurance company I have ever dealt with!! I have never had this kind of experience with a business in my lifeFrom the moment I enrolled they have not done anything I asked of themI should have known when they couldn't even identify my check when I sent them my premium That is just the beginning! After a series of events(that is too long to go into), I asked to speak with a supervisorWOW how did he get his job? Did absolutely nothing and was very condescending.I have called so many times that I know the number by heart! If I could change insurance companies I would, NY doesn't offer anything else thats worth itI do not mind Obamacare, it saved me money but the people who work for Affinity are isThey have no idea what they are doing and don't care about their customers!!! Someone please do something!!! I am so done What do I have to do to get someone to do their job!!!

Upon receipt of your concern, the Plan’s Enrollment Department was contacted and a representative from that department advised that due to an internal error that occurred with the
Plan’s Enrollment vendor, invoices were generated with the incorrect premium amount. The representative further confirmed that the error has been corrected and the correct premium amount is $and that you are paid through June **, Leadership from the same department further advised that going forward; the Enrollment team will perform a quality check on invoices before they are sent so that this does not recur The Plan apologizes for any inconvenience this matter may have caused you
Reugenia S***
Director Appeals and Grievances

Upon receipt of this complaint, a review of the member's authorization requests were reviewed and revealed that an authorization request for *** *** was received and was denied on March *, by one of the Plan's Medical Directors because the services were deemed not medically necessary. The member's appeal request records were reviewed and revealed that to date; the member has not submitted an appeal for the same denialThe Supervisor of Member Services was contacted and asked to review the member's call history for any complaints regarding long wait times and dropped calls. The Supervisor advised that there were a number of inbound calls from the member but there was no documentation regarding long wait times or dropped calls. The member needs to provide specific dates that these incidents occurred so that we can investigate further.
The Clinical Pharmacy Manager was contacted and advised that the member's records were reviewed and revealed that most of the member's claims were paid with the exception as oneThe claim rejected because the member attempted to refill the medication too soon. In addition, the member's records did not show a request for reimbursement for out of pocket expenses for medications.
Sincerely,
Reugenia S***
Director of Complaints, Grievances and Appeals

Upon receipt of this complaint, the Supervisor of Affinity’s Membership Accounting department was contacted regarding the HOH’s concerns and advised the premium for the member’s
increased from $to $because of a change in income in the householdThis information was provided to the Plan from an Eligibility File (834) that is sent by the Exchange If the member’s premium rate changes, the member’s enrollment is pended until the payment is receivedAlthough the HOH was not behind with the premium payment and the funds were directly deducted from her account, the correct premium payment needed to be received before March *, to be currentThe premium payment was set to come out on the 10thBased on the Plan’s findings, the HOH stated that she is fine with the Plan not refunding her the premium payments of $that were made on March *, and March **, because the payments will be applied to the upcoming premium payment due. The Supervisor contacted the HOH to explain what occurred and she acknowledged that she understood The Supervisor stated that the HOH is still seeking the refund for the $she paid out of pocket for her son’s doctor’s office visitThe Supervisor advised that he would call the doctor’s office and assist the HOH with her request for reimbursementThe Plan apologies to the Head of Household for any inconvenience this matter has causedSincerely,
Reugenia S***,
Director of Complaints, Grievances and Appeals

The Plan did receive a grievance from the member regarding preventative services that were rendered to her on 03/**/and alleging that the claim was processed incorrectly which showed that there was member
liability. Upon receipt of the grievance, the case was assigned to an Appeals and Grievances associated who reached out to the claims department regarding the members concerns. The Claims Department reviewed the claim and reprocessed the claim to pay as preventative care with no member liability. The member will also receive a written response to her grievance. Please see the response that was received from the Claims DepartmentClaim # *** has been backed out to reverse the member deductible which was incorrectly appliedNew Claim # *** paying in full now Claim # *** has been backed out to reverse the member deductible which was incorrectly appliedNew claim # *** paying in full nowI trust that this has resolved the matter for the member
Thank you,
Reugenia S***,
Director of Appeals and Grievances

I work for a medical providers officeI call insurance companies nearly everyday for different reasons, but ive never dealt with a provider line that has a wait time of 30+ minutes no matter what time you call during the dayI have called first thing in the morning, minutes before they close, during lunch and any other random time during the day, and I haven't gotten a shorter wait time than minutesLast time I called, I waited for minutes and when it rang to the representative, they hung up immediatelyI have a job to do and I'm not fully able to do it when I'm waiting on hold for so long just to have a minute phone callThey are very quick once you reach themI just don't understand why I need to wait this long when they don't take long to respond to questions
As a comparison, we are in network with different insurance companiesThe longest wait time I've ever had from another company was minutesAffinity has had me on hold for an hour and minutesI finally had to hang upThey urge everyone to use the web portal but it doesn't provide the benefits we need for the providers specialty and it doesn't provide specific claim information that we also need to know

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# ***, and have determined that my complaint has NOT been resolved because:
This is an explanation of what happened and I appreciate Affinity letting me know how the issue was causedI am more concerned with a solution to the issueI understand that I now have a credit for $which will be applied and used for the April premiumI am still concerned as to how I will receive the $refund for the doctor's fee that I had to pay out of pocket.
As a suggestion, Affinity should notify customers about the issues that can arise when the premium has changedNo one notified me that the payment was due before the 1stAs usual I expected it to come out of the 10th as it has been for yearsIn addition this issue caused my children to not be insuredImagine if the issue of my son getting sick was more serious and he didn't have health coverageI wasn't notified in any way that he coverage was being cancelled due to my premium going up.
I would like a final answer as to how and when I can expect my $refundIt is absurd that I have to go through the Revdex.com to get a valid response and I am still be given the run around.
In order for the Revdex.com to appropriately process your response, you MUST answer the question above
Sincerely,
*** ***

Affinity Health Plan takes Customer satisfaction very seriouslyWe strive to create a positive impression with every Customer encounterTherefore we were dismayed to receive this complaint filed through the Revdex.com.
This Member complained of
difficulty:
Getting premium payments posted to her account,
Receiving accurate Member identification cards for her family, and
Obtaining information about a proposed surgical procedure
Affinity Health Plan worked diligently to investigate and positively resolve these issues for this MemberAll of her concerns were successfully resolvedWe conducted a follow up call to the Member and she expressed satisfaction with the resolutionsWe also provided a staff member that can be called directly with any additional concernsThe Member stated that this phone call, and provision of a direct contact, was a very positive experience

Tell us why here
*** ** ***
*** *** ***
** *** *** ***
*** *** ** ***
*** *** *** ***
Dear Revdex.com:
Thank you for bringing this member concern to our attentionWe welcome the opportunity to respond
to the issue raised
The Member stated that he enrolled with Affinity Health Plan via the New York State of Health website in order to be active for 3/*/He complained that he never received an ID Card and welcome packet, but received a termination of coverage letter on or about 4/**/The member wants to have his coverage reinstated with a write off for the months that he did not have coverage
This Member’s coverage was terminated because we did not receive his initial “binder” paymentFailure to make the binder payment will result in coverage terminationWe reviewed this complaint reinstated the Member’s coverage effective back to March Affinity Health Plan wrote off the months that the member could not access careAt the time of enrollment we were experiencing issues with our enrollment files which resulted in some delays in getting ID cards generated and mailedWe ordered a new temporary ID card for this Member and will send a permanent card when he has selected a primary Care Provider from our networkWe discussed this resolution with the member on 7/*/and he is in agreement
We take our Member’s concerns seriously and continue to work diligently to permanently resolve these issuesWe thanked him for his patience while we resolved his concernHe has been provided with my direct dial should he have additional concerns
Sincerely,
*** *** ***
*** *** ***
*** *** *** *** *** ***
*** *** *** *** ***
*** *** ***
*** *** ***
*** ***

Upon receipt of this complaint, the Plan’s Enrollment/Billing Department and vendor liaison were notified of the member’s request for her *** form. It was discovered that due to an internal processing error, the vendor did not generate a *** form for this member. On March ** , 2016, an urgent request was submitted to the vendor who was able to generate the *** form for the member. The Director Complaints, Grievances and Appeals obtained a copy of the *** form and emailed a copy via secure email to the member. Before emailing the form to MsBell, the Director contacted the member to confirm her email address asked her to confirm when the form was received. The Director also apologized for the delay and inconvenience this matter may have caused. On March **, the Director called the member to confirm if the *** form had been received. As the member was not available, a message was left. A copy of the requested *** form has also been attached to this response
Sincerely,
Reugenia S***
Reugenia S***
Director, Complaints Grievances and Appeals
Complaint, Grievance and Appeal Unit

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# ***, and have determined that my complaint has NOT been resolved because:
[Your Answer Here]
Here we go againI'm accused of being dishonest by a company who made specific claims about their services that were not true in any wayIt's true that my wife has been able to use the insurance, after spending approximately hours on the phone per doctor, and sorting through inaccurate and untrue information provided by Affinnity's websiteMy complaint was specifically regarding the terrible, misrepresented service Affinity provided to me
Their staff was variously unhelpful, rude, or supplying inaccurate information every time I calledThe senior representative who wrote me a letter completely changed her story in between the first and second time we spoke, and I would not have signed up for this service if I'd known that the information on their website was a lie.
I'm apparently stuck with these frauds until the end of the yearI will make sure that every social media outlet I can find is flooded with the story of how they've treated me
In order for the Revdex.com to appropriately process your response, you MUST answer the question above
Sincerely,
*** ***

I wish to express my displeasure with your customer service representative Louis DHe seemed to be in a hurry to get me off of the phone and in my opinion I wasn't even finished speaking to himI asked him if he was in a hurry and he did infact say yes and that the call volume was high and that he answered my question......his last statement I found to be very presumptuous However Mr Louise D of the Qualified Health Department needs a lesson in handling customer queries and as result I decline to renew my policy with Affinity.....Poor customer service

Upon receipt of this complaint, the Director of the Appeals and Grievances Department reached out to an Enrollment Resolution Specialist who advised that this member was indeed MEDICAID active with during...

the Qualified Health Plan ([redacted]) date of service 10/*/2015.
 
Member’s 2015 [redacted] enrollment has cancelled and a refund  will be issued to the member's VISA in the amount of $316.54.  The member’s refund should be issued within 2-3 business days.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:

[Your Answer Here]
 
When the company finally got back to me, the person I spoke to sounded shocked and upset that I was treated the way I was, and told me there were many urgent care facilities I should have been referred to. 2 weeks later I received a letter from the same woman that stated that even though Affinity had advertised that there were places I could go for urgent care treatment (one of the reasons I selected them) They were not obligated to honor the information on their website, and that they were justified in telling me to use the emergency room. Furthermore, they say nobody raised their voice to me. I understand that because my wife has seen a doctor this year, they will not give me a refund, but they are obligating me to keep paying them for service they refuse to deliver on, on penalty of both my wife and I losing insurance for the rest of the year. I am being defrauded.
 
 
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]

While requesting for pre-auth for procedures, the calls for Affinity Health Plan ###-###-#### were all transferred to call center for messages. After multiple calls and long waits, phone calls were all answered by representatives, where calls are DISCONNECTED, multiple times. Pre-auth was started on 07/**/16, upon calling on 08/**/16 and 08/**/16, reps defends by saying they need 2 weeks for processing pre-auths. No nurse managers were available to assist on expedited cases. Three phones were transferred to care managers were they were unavailable to speak, with only voice mails for messages. This is great inconvenience for patients and providers. This is not the correct way to provide care for any patients.

Affinity Health Plan (AHP) is in receipt of a complaint that was submitted on behalf of Donna Deming by the Revdex.com and was received on...

March **, 2016.   The member states in her complaint that she and her spouse have been unable to access the dental benefit since enrolling in the Plan effective January *, 2016.
 
Upon receipt of this complaint, the Director of the Plan’s Enrollment/Billing Department and vendor liaison were notified of the member’s inability to access their Dental Benefit.   It was discovered that due to an internal processing error, the information required to add the member to the dental vendor’s eligibility file was not forwarded.  As a result, the members did not appear as active in the DentaQuest system.  On March **, 2016, an urgent request was submitted to DentaQuest to add the members to their system.  On March **, 2016, DentaQuest confirmed that the required information was received and both members reflected as active in their system.
 
The Plan extends an apology to the member for the inconvenience that this matter has caused.