Affinity Health Plan

Affinity Health Plan takes Customer Service and Satisfaction very seriously. We make every attempt to process applications for health insurance coverage in an expeditious and thorough manner. However, our...

member enrollment process is governed by the New York State Department of Health and we must adhere to the rules and regulations they have set forth. Premium payment for the first month or coverage must accompany an application for health insurance coverage. This Complainant submitted two applications (December 2013 & March 2014) without payment despite a reminder letter requesting payment, and therefore neither application resulted in insurance coverage. A third application was submitted in June and premium payment was received. Insurance coverage for the applicant was activated on July *, 2014, in accordance with NYSDOH regulations. There was no delay or departure from our State governed process and we are pleased that the Complainant no has the coverage for her family member.
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Revdex.com:At this time, I have not been contacted by Affinity Health Plan regarding complaint ID [redacted].  I did however contact them on Thursday March [redacted] to follow up on their promise to have sent out my refund check as they...

said they would.  I was promised that the check would be cut on THursday March [redacted] and sent out. When I called them on Thursday Mach [redacted], I was told that they could no longer speak to me regarding this matter because they received a complaint from the Revdex.com and that is why the check was not sent out.  They told me that the Revdex.com complaint was received on Wednesday the [redacted], so this is yet another fabrication.  If they received the complaint on the [redacted], the check would have already been cut and sent out on the [redacted], which they obviously lied about... again.I was told that this has been given to their legal dept and that they will not speak to me regarding this issue.
Sincerely,[redacted]

At this time, I have been contacted directly by Affinity Health Plan regarding complaint ID [redacted] however my complaint has NOT been resolved because:
They are working toward resolving my complaints at this time. The issue about  ID cards has been resolved as of Friday, March **, the complaint dept from Affinity contacted me on friday by phone and I rec'd the ID cards in the mail.
we are currently working on the miss-communication, and the lack of education of their employees and at this time.  Affinity assures me they are working on this at this time.  I am hoping to see some results shortly. We will see if they will follow through on their issues. WE Still have not rec'd billing Invoices in a timely manner, My son's ID card arrived, but the wrong MD still on it, as they have not "loaded" his MD into their computer as of yet.  and have not rec'd a physician directory. the complaints dept I spoke w on friday said she will help me resolve these issues, as they are taking my complaints seriously since I filed a report w you.  I will keep you informed if they follow through and all uissues are resolved.  Today is March **, we have NOT rec'd the billing invoice they said should have been mailed out on March [redacted]  And then they demand payment made by March **.....giving us little time to get thru the mail and processed! They definitely need to work on their company organization and mailing lateness issues.  thank you for your assistance in this matter.
 
 
 
 
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]

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
the business responded on 10/**/16 to the Revdex.com that they would initiate a refund within 48-72 hours. It is now more than 72 hours and I've not been refunded as of yet. Once I receive the refund into my account I will re-evualate my response and accept to close this out.
 
 
 
 
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]

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 Affinity. The NY State of Health requires a new confirmation number to reinstate health plans. Since 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 me. Unless 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]

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 life. From the moment I enrolled they have not done anything I asked of them. I 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 supervisor. WOW 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 it. I do not mind Obamacare, it saved me money but the people who work for Affinity are is. They 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!!!

The New York State of health is responsible for providing members with the tax forms ([redacted]), not the individual health plans. We confirmed the dates this former member was active with us and requested a  [redacted] statement be sent to her on her behalf.
Should you have any questions, she...

can contact me toll free at ###-###-####.Tracey Purdue, R.N.
Complaint, Grievance & Appeal Sr. Coordinator

0pt;">Upon receipt of this complaint, an Enrollment Specialist was contact and advised that the Enrollment Departments records revealed that member ID cards and Handbooks were sent on 3/*/16 and again on 3/**/16 to:
 
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The Enrollment Specialist further advised that she was successfully able to log into the members account using both the Affinity ID and Exchange ID number and access the area to print temporary ID cards. The specialist also purposely entered an incorrect ID number to confirm that contact information is provided to users when they are experiencing difficulty logging in.
 
The Enrollment Specialist also confirmed that the departments return mail log was reviewed and she was unable locate any returned mail for this member.
 
Based on the Plan’s findings, the members request for reimbursement cannot be approved.
 
Copies of the member’s ID cards and Welcome letter have been attached to this response.
 
Sincerely,
 
[redacted]
*
[redacted]
[redacted]
[redacted]

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]

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]...

Dear Revdex.com Mediator: Thank you for bringing this Memberconcern to our attention. Affinity Health Plan has looked closely at thisconcern and made the following decision:  Grievance: This Member complained that...

sheenrolled with our health insurance plan to be effective on 03/**/2015 but atthe time of filing this complaint had not received an ID card.                                     �...⇄ Response:At the time of enrollment wewere experiencing issues with our enrollment files which resulted in somedelays in getting ID cards generated and mailed. We ordered a new ID card forthis Member on 03/**/2015 which was successfully delivered by [redacted] on04/**/15, reviewed and accepted by the Member on 04/**/15. We take our Member’s concernsseriously and continue to work diligently to permanently resolve these issues.We thanked her for her patience while we resolved her concern. She has beensent a separate letter outlining our responses and provided with my direct dialshould she have additional concerns.    [redacted]Revdex.com Complaint #[redacted]  Pleasenote that Affinity Health Plan hopes we have resolved this grievance to yoursatisfaction. If you have any questions regarding this decision, you maycontact the Complaint, Grievance and Appeal Unit at Affinity Health Plan bytelephone at ###-###-#### or TTY/TDD at ###-###-####.  Ifyou remain dissatisfied with this grievance determination or if at any othertime you are dissatisfied, you may: Call the [redacted] at###-###-#### or write them at: [redacted]
[redacted]
  Sincerely,[redacted]AffinityHealth PlanCc:File    If you do not speak English or have special needs, we have other ways of giving you this information. Call us toll-free at [redacted]

Medical Provider Customer Service is extremely bad. In my experience the wait time for a representative is very long. The first representative could not access a system to check a payment information. The second had a computer crash and placed me back in the wrong waiting line. The third, took my information and placed me back in the waiting line without a word. All these over tens and tens on minutes waiting to speak with someone. And every time we call for an issue the story repeats one way or another.

Upon receipt of your concern, the Plan’s Enrollment Department was contacted and  a representative from that...

department advised that your newborn was enrolled in a Qualified Health Plan (QHP) Platinum  16 plan and that newborns are covered under the member’s QHP plan for 60 days effective their date of birth. Due to an internal error that occurred with the Plan’s Enrollment vendor, invoices were generated with the incorrect premium amount.  The representative further advised that you did speak with a supervisor on June *, 2016 who advised you that the he would reach out to the New York State Department of Health to correct the error.
The representative confirmed that the error has been corrected and the correct premium amount is $549.08.
The Plan apologizes for any inconvenience this matter may have caused you.
 
Reugenia S[redacted]
Director Appeals and Grievances

Review: all I want is a customer service rep to actually help. all I wanted was to renew my plan. only wanted some one to help with the renewal process. tired of being transferred from one rep to another, put on hold for 10 mins at the minimum on the average. tired od my calls lasting atleast an hour every time I call. tired of being put on hold and being hung up on.Desired Settlement: I dont know if its worth it to stay with this company

Review: I signed up for health insurance in November to be effective as of January *, 2015. I paid the first months premium on December [redacted] and still have not received insurance ID cards in the mail. I called a few times. One time I left a message and no one ever called back. The other two times I spoke with people who said that I wasn't "in the system" even though they mailed me an invoice with a membership ID # on it and took the money for the first months premium out of my bank account. I also have a username and am all set up on there website. I ask to speak to their managers, but they tell me to call the New York State of Health or just put me back to the main phone menu. This is completely unacceptable.Desired Settlement: I would like them to overnight us our ID cards so that we can actually use the insurance that we have already paid for. I also want there employees to be able to find me on the computer system when I call. They should also reduce our premium for the first month since we haven't been able to use the insurance this whole week.

Consumer

Response:

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,

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 life. From the moment I enrolled they have not done anything I asked of them. I 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 supervisor. WOW 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 it. I do not mind Obamacare, it saved me money but the people who work for Affinity are is. They 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!!!

Review: I chose Affinity Child Plus for my daughter from the NY State of Health Exchange. I made payment to the company which was chased on 06-**-2014 and never received insurance cards. When I call and ask why they say that NY State of Health does not have my daughter listed as an active account. When I call NY State of Health they say they've sent the information over to Affinity several times already. This has been the back and forth that I've gone through since December 2013. I finally sent in payment last month just to see if that would get the coverage active and the cards issued. It didn't work. I'm not sure where they applied the $9 I've already paid and why I haven't received the cards. I just need help resolving this issueDesired Settlement: Coverage confirmed and ID Cards issued.

Business

Response:

Affinity Health Plan takes Customer Service and Satisfaction very seriously. We make every attempt to process applications for health insurance coverage in an expeditious and thorough manner. However, our member enrollment process is governed by the New York State Department of Health and we must adhere to the rules and regulations they have set forth. Premium payment for the first month or coverage must accompany an application for health insurance coverage. This Complainant submitted two applications (December 2013 & March 2014) without payment despite a reminder letter requesting payment, and therefore neither application resulted in insurance coverage. A third application was submitted in June and premium payment was received. Insurance coverage for the applicant was activated on July *, 2014, in accordance with NYSDOH regulations. There was no delay or departure from our State governed process and we are pleased that the Complainant no has the coverage for her family member.

Review: We were forced to sign up with the NY health exchange w an insurance co.....we have nothing but problems w this Affinity Health Plan since we signed up in Dec 2103. WE pay our premiums (they called a few times to say we didn't), we confirmed w canceled check, but they made us pay AGAIN immediately over the phone w credit card. NOW, after 6 calls about getting Member ID cards.....(and after about 6 "excuses")...we finally rec'd the cards, but the children's cards need to have MD names added. I called AGAIN today, and the cuts serve rep said the "children" needed to call themselves to get the names added to their cards! ---EVERYTIME I call, they make up ANOTHER ridiculous excuse for NOT mailing out ID cards!..... I have paid my premiums, and they are refusing "service" EVERY TIME I CALL....we get the run around! Someone need to EDUCATE this new insurance company about the proper "business" procedures and how members are ENTITLED to their member ID cards!......I can't seem to get ANY satisfaction w this company. I was supposed to have surgery last week, and had to cancel it because the provider could NOT get authorization for the procedure after calling them for over 2 wks!...they kept giving them the run around. This is NOT the way a Health care company should be operating. ALSO< We STILL have NOT rec'd ANY policy/Member benefits ext from them either!.Desired Settlement: I would like this Affinity Health Care plan to provide my entire family with Member ID cards and our member benefits policy and TRAIN their employees to work WITH the members and not AGAINST them and provide information and healthcare as they should be. Each time I call there, they give another excuse. THIS TIME they said each member needs to call to get their own member ID card. So, my Children, are supported to stay home from school and call the insurance company? does that sounds reasonable to you? I THOUGHT thats why I was the parent and guardian and was suposted to be able to do this. We even sent a letter (which they confirmed they rec'd and have on file) from my husband, the policy holder) giving me FULL authorization to handle the benefits and make any changes for our entire family.. I REALLY just want ID cards for my family. When they FINALLY sent them, they were "DUMMY" cards and said we had to call AGAIN to give the names of our PCPs (AGAIN) as I did previously 6 times.....in order to get NEW/REAL Member ID cards! Is there anyway this can be rectified? can someone look into this new company and tell me they are upstanding and if all members are experiencing similar problems w their lack of knowledge and customer service and care.

Business

Response:

Affinity Health Plan takes Customer satisfaction very seriously. We strive to create a positive impression with every Customer encounter. Therefore we were dismayed to receive this complaint filed through the Revdex.com.

Review: Below is the link to my plan that I purchased through the marketplace. It outlines the summary of benefits...

[redacted]I am receiving a bill from an out of network hospital (emergency room visit )that I took my daughter to on 9/**/2015. According the affinity's website(see link above) if I visit an out of network hospital there will be no charge to me except for a $100 copay. I have contacted affinity several times regarding this manner and they keep telling me to file an appeal with affinity. When I call the appeal number I get a voicemail and no one calls me back!! I have tried for the last 5 days!Desired Settlement: For affinity to settle the hospital bill as per required acording to the company's QHP summary of benefits

I wish to express my displeasure with your customer service representative Louis D. He seemed to be in a hurry to get me off of the phone and in my opinion I wasn't even finished speaking to him. I 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.