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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 In addition, the member's records did not show a request for reimbursement for out of pocket expenses for medications.ĭirector of Complaints, Grievances and Appeals 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. The member needs to provide specific dates that these incidents occurred so that we can investigate further. 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'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. 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.
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: 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: 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 to appropriately process your response, you MUST answer the question above Sincerely, ***