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Affinity Health Plan Reviews (46)

Review: Approximately a month ago, I had [redacted] Since I'd purchased a gold plan through Affinity on the NY state exchange (my wife and I pay approximately $700 per month), I figured I'd go to the doctor, get checked out, get penicillin if I needed it.

Starting on a Thursday evening, I went on the Affinity website to find someone to see. To my surprise, of the several doctors listed in my borough ( I live in Manhattan) several did not exist, one was the number of a homeless shelter, another was a drug rehab facility. I searched for a GP, a Nurse Practitioner, anything I could get. This represents about 2 hours of internet searches and calling on Thursday evening.

On Friday morning, I renewed my search, while trying to go to work (if I don't work, I don't get paid, so I work when I'm sick). I started making calls to doctors and emergency care facilities. I finally found one emergency care facility that said they accepted Affinity from the exchange. When I got there, after waiting over 45 minutes, they told me that Affinity would not honor my insurance. I called Affinity, spoke to a representative, who, after an hour on the phone, told me that there was _no doctor or emergency care facility in NYC I could use_. The closest one available to me through my Gold plan was in [redacted], a 2 hour ride by car. When I asked to speak to her [redacted], I was put on hold for another hour, and was eventually connected to a man who raised his voice to me, and told me that "If this is an emergency, go to the emergency room, otherwise, there are no doctors for you."

I've already submitted a complaint through the exchange, and to my assemblyman. Apparently I'm not allowed to change providers, even though I'm legally bound to purchase insurance. As far as I can tell, I have been defrauded, and have to keep paying these people until the end of the year. I consider this an outrage, and I hope to find some recourse here.

I did not hear back from Affinity until I contacted my local Assemblyman. They made a call, and I was contacted by the complaints department the next day. The woman promised to investigate, and contact me the day after, but I have not heard from her over a week later.Desired Settlement: I no longer wish to do business with Affinity, but the insurance exchange will not let me change until the end of the year. Affinity refuses to deliver their promised services, and I'm stuck paying them $700 a month until December. I would like to change insurance companies immediately, and ideally, would like a refund of the money I've spent with them.

Business

Response:

Dear Revdex.com,

Thank you for bringing customer complaint ID [redacted] to Affinity Health Plan’s (Affinity) attention. I appreciate the opportunity to respond and set the record straight.

Please be aware that Affinity did respond directly to the complainant in a letter dated August **, 2014. In addition, an experienced, [redacted] who also is a registered nurse in Affinity’s Complaint, Grievance and Appeal Unit within our Quality Management Department, personally called the complainant and spoke with him twice.

Respecting patient privacy provisions, I also note that despite the single situation referenced in the complaint’s letter, the complaint’s family has benefited from having health insurance through Affinity Health Plan.

As to the complaint’s specific grievance, Affinity spent considerable time and effort examining the customer service experience and presented to the complainant a recommended course of action.

Affinity is constantly working to maintain our online provider website and keep the listings current. We were not able to replicate the complainant’s search results but sincerely apologized to him for any inconvenience. As discussed with the complainant during a telephone conversation on 8/**/14, when a member is sick and needs to be seen quickly, and the member’s primary care provider is not available, emergency room care is an option and is a covered benefit. Affinity is aware that the member was referred to an urgent care center in [redacted]. Affinity is working to expand urgent care centers in our network. In our response to the complainant, we provided a list of providers that accept Affinity Essentials close to the member’s home, and our customer service team was able to confirm confirmed appointment availability for new members, several within 1-2 days.

Affinity expects all members to be treated in a courteous and professional manner by both our providers and staff at all times. Although it is clear that this situation was upsetting to the complainant, Affinity reviewed the call logs from his calls to our customer service center, and we were not able to confirm that any representative or [redacted] “yelled” or spoke rudely to himhim. Affinity takes every member complaint seriously, and we constantly strive to improve service to our members.

Affinity sincerely hopes that the complainant will access one of the providers we identified for him and remain with Affinity Health Plan. Of course, it is his and his family’s right to disenroll, however, we properly advised him that if he does so immediately, his family will not be able to obtain health insurance with another plan until January 2015, unless there is a qualifying life event. Open enrollment for the 2015 benefit year will be 11/**/14 – 2/**/15. Additionally, Affinity paid claims on the member/ family’s behalf to health care providers. Therefore, it is neither possible nor appropriate for Affinity to refund premium payments.

Affinity remains available to help members navigate the health care system in order to reach and maintain their health care goals. We encourage members to call our customer service department toll free at ###-###-#### with any questions or concerns.

On behalf of Affinity Health Plan, I hope this information and attention to the complainant’s concerns help to resolve the previous experience with our customer service representatives.

Sincerely,

Consumer

Response:

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,

Business

Response:

[redacted]

Dear Revdex.com,

Thank you for bringing customer complaint ID [redacted] to Affinity Health Plan’s (Affinity) attention. I appreciate the opportunity to respond and refute the complainant’s dishonest, exaggerated charges.

Despite the complainant’s allegations, his family has, in fact, benefited multiple times from having health insurance through Affinity Health Plan. Respecting patient privacy laws, I am not permitted to expand further on this point. I can state affirmatively that Affinity’s networks of physicians, hospitals and related health care services have been utilized by the complainant’s family. To claim he was “defrauded” and other exaggerated allegations are simply not true.

Please be aware that Affinity did respond directly to the complainant in a letter dated August **, 2014. In addition, an experienced, [redacted] who also is a registered nurse in Affinity’s Complaint, Grievance and Appeal Unit within our Quality Management Department, personally called the complainant and spoke with him and his wife at least three times. During each call, the complainant and his wife were resistant to even want to try to work toward a resolution.

As to the complaint’s specific grievance, Affinity spent considerable time and effort examining the customer service experience and presented to the complainant a recommended course of action.

Affinity is constantly working to maintain our online provider website and keep the listings current. We were not able to replicate the complainant’s search results but sincerely apologized to him for any inconvenience. As discussed with the complainant during a telephone conversation on 8/**/14, when a member is sick and needs to be seen quickly, and the member’s primary care provider is not available, emergency room care is an option and is a covered benefit. Affinity is aware that the member was referred to an urgent care center in [redacted]. Affinity is working to expand urgent care centers in our network. In our response to the complainant, we provided a list of providers that accept Affinity Essentials close to the member’s home, and our customer service team was able to confirm confirmed appointment availability for new members, several within 1-2 days.

Affinity understands it is the complainant’s right to disenroll, however, we properly advised him that if he does so immediately, his family will not be able to obtain health insurance with another plan until January 2015, unless there is a qualifying life event. Open enrollment for the 2015 benefit year will be 11/**/14 – 2/**/15.

Affinity remains available to help members navigate the health care system in order to reach and maintain their health care goals. We encourage members to call our customer service department toll free at ###-###-#### with any questions or concerns.

On behalf of Affinity Health Plan, I hope this information and attention to the complainant’s concerns help to resolve the previous experience with our customer service representatives.

Sincerely,

Consumer

Response:

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]

Here we go again. I'm accused of being dishonest by a company who made specific claims about their services that were not true in any way. It's true that my wife has been able to use the insurance, after spending approximately 3 hours on the phone per doctor, and sorting through inaccurate and untrue information provided by Affinnity's website. My 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 called. The 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 year. I 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,

Review: Affinity Insurance Company has failed to provide my child with insurance coverage despite receiving my application and cashing my payment.

My account was initially cancelled on September **, 2014 due to non-payment. As such, I re-applied with Affinity on October **, 2014 and provided payment for the month of November, 2014 (the month my insurance was to become active). My next payment was to be submitted before December **, 2014. On December [redacted], I attempted to make a payment and was advised that my account had been inactive since October **, 2014. To show that Affinity was in error, I provided proof of my application, proof of payment, application confirmation number and the name and number of the representative who took my application. I advised that I had not received any cancellation notices or letters stating an issue with my application/coverage. Of note is my inquiry with [redacted], which showed that the money order I submitted to Affinity was cashed on October **, 2014.

I have had repeated contact with the company. Despite speaking with multiple representatives, the problem remains unresolved. Each representative has promised to investigate the problem and return my call by a certain date/time, however each has failed to follow through. All my attempts to speak with a [redacted] were ignored. On January *, 2014, a representative by the name of [redacted] accepted responsibility for the error. She stated my application was accepted on October **, 2014, and that her [redacted] was to make sure my account would be active immediately. She promised to return my call by 1:00 p.m that day. She did not; and to date my account remains inactive.

My son suffers from [redacted] and is currently having symptoms of same. Due to this error by Affinity, I have had to cancel a doctor's appointment and have not been able to seek treatment. I have made Affinity aware of this on two occasions, and advised that not seeking treatment for [redacted] early on can lead to exacerbation and hospitalization. He has been hospitalized for [redacted] in the past. I advised Affinity of my immediate need for correction of this error.Desired Settlement: I want Affinity to correct my account so that my son has coverage immediately. Further, Affinity would not take my payment for December, 2014 due to the "inactive" status in their system. As the the error is on the part of Affinity, my membership should not be cancelled due to non-payment for the month of December, 2014. Finally, I want Affinity to take financial responsibility for any medical bills incurred while this issue remains unresolved.

Review: In December 2014 I renewed a health plan through this carrier. I never received an id card. I paid my premiums faithfully each month and never received invoices. I contacted the company several time for an id card and to confirm my coverage and payments, each time to be told everything is fine and I will have an id card in two weeks. Long story short I go to renew my policy in December 2015 only to find out that my policy was never active. Yet the company had cashed all of my checks totalling $7508. It even showd as a credit in my online account. I contacted the company so many times, I cannot count and was told that I was to receive a refund within four weeks. I am three weeks in and received an invoice today stating I owed a balance of $648!!!! I want my money refunded as I had to pay a fine through my taxes as nothaving the insurance. I never used the plan, never received an id card, no bills, they just cashed my checks! Disgusting company, disgusting customer service. They will not even allow me to speak with a supervisor. At my wits end!Desired Settlement: I want my money refunded as I had to pay a fine through my taxes as not having the insurance

Consumer

Response:

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]

This insurance carrier sends out confusing bills in what I can only surmise is an attempt to get customers to double pay for services. I have called three times now, once 5 days ago and twice today. Every time I call to inquire if my premium has been paid they tell me all agents are busy and I must leave a name and phone number. I have yet to recieve a call back.

Review: Affinity Health Plan was assigned to me as my 2015 health care provider by New York State of Health.

In the following months, up to late April 2015, I never received an enrolment/payment package from Affinity Health Plan. On 4/**/2015 I received a policy cancellation letter from Affinity without any prior inquiry from them to make a payment towards my 2015 coverage.

Following April **, 2015, I contacted Affinity to speak with them as to why they had cancelled my policy without notifying me. The representative and [redacted] verbally recognised that it was Affinity Health Plan's mistake for not mailing out my enrolment/payment package. At that point the representatives verbally promised that they have re-activated my health plan and that I should be expecting an enrolment/payment package in the mail by June *, 2015. Once I was to receive my health plan, I could begin my monthly payments of $62.75. I asked the [redacted] to make a payment over the phone using my credit card, but she said that was not an option and that I should wait for the mailed information. That day, they gave me a case number, but could not provide me with a mail tracking number nor other confirmation of the package via e-mail nor telephone.

On June *, 2015 I contacted Affinity Health Plan to ask why my health coverage and payment method was never sent in the mail. Once again, I spoke with a representative and a [redacted] regarding my case. We used the same case number that was previously assigned to me, but could not tell me why the enrolment/payment package was never sent. During that conversation, the [redacted], verbally promised that they would send a second enrolment/payment package to be received by June **, 2015.

On June **, 2015, I called Affinity Health Plan asking why I had never received my enrolment/payment package, while two previous [redacted]s had given me a verbal promise that the packages were sent. The [redacted] I spoke with, said that they had lost my case number and I was once again dis-enrolled from my health coverage. Just like the previous months, they had dis-enrolled my health coverage without any notification. The [redacted] which I spoke with, confirmed that she had re-enrolled my coverage on June **, 2015 with a new case number and that I should be expecting a confirmation of my active insurance prior to June **, 2015. This time, the [redacted] said that I would have to pay a coverage of $240 in order to compensate for the months that I was not covered, but "enrolled" since February 2015. This new balance is now contradicting the information that was given to me by the prior two [redacted]s that I spoke with following April **, 2015 and on June 1, 2015.

On June **, 2015 I reported this case with New York State of health and they said that Affinity Health Plan had not updated them on my case at all, nor had they sent them any information regarding the previous cancellations of my policy.Desired Settlement: I would like to receive my active health coverage as promised, and not to pay for months when I was not insured by Affinity Health Plan

Business

Response:

Tell us why here...

[redacted]

[redacted]

Dear

Thank you for bringing this member concern to our attention. We 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/*/2015. He complained that he never received an ID Card and welcome packet, but received a termination of coverage letter on or about 4/**/2015. 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” payment. Failure to make the binder payment will result in coverage termination. We reviewed this complaint reinstated the Member’s coverage effective back to March 2015. Affinity Health Plan wrote off the months that the member could not access care. At the time of enrollment we were experiencing issues with our enrollment files which resulted in some delays in getting ID cards generated and mailed. We 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 network. We discussed this resolution with the member on 7/*/15 and he is in agreement.

We take our Member’s concerns seriously and continue to work diligently to permanently resolve these issues. We thanked him for his patience while we resolved his concern. He has been provided with my direct dial should he have additional concerns.

Sincerely,

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,

Review: I signed up for health insurance in February to be effective as of March *, 2015. I paid the first months premium on March * 2015 and still have not received insurance ID cards in the mail. I have called four times being told that a reissued card would be mailed out. I didn't receive the first second or third card. They told me each time it would take 7 to 10 business days. I never received the card. On, one call I was told that I could print out a temp card. I went on the site to print out the card and found the card to print out in the size of about an inch in size. As, a member of this health plan it horrible. They seem to have the correct address for billing my monthly statement. The bill seems to get to me alright but, not my card. This is completely unacceptable.Desired Settlement: I want my medical card

Business

Response:

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]

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]

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Description: INSURANCE-HEALTH

Address: 2500 Halsey Street, Bronx, New York, United States, 10461

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