Guys, im having a problem whereby i don't who to be blame rite now?

on the 26 Oct, im having a health problem, which is chest pain n cold sweating during sleep, so the next morning my wife suggest go to hospital to get a treatment/checkup.

so i went to ampang puteri hospital emergency, first the brought me to ECG (to check heart rate), after that i met the cardiology specialist, n during checking the doctor still dont know the cause

of chest pain, and mention to me to go through all test. so i say ok n give my medical card which is under MCIS Zurich n according to the doctor i need to stay in hospital (warded) upon checking)

n i have run all test including blood test, glucose test, CTA scanner, treadmils, xray etc.

so all went normally n i stay for 3 days 2 night at the hospital. and the result was ormal, nothing wrong with my chech.

during my discharge, total charge is around 4.5k++, n what was shocked is the insurance did not cover all the expenses, the reason is i was normal.nothing wrong with my bodies and asked me to pay all.

and im saying why i gonna pay? thats why i take medical card, to cover all the expenses. n according to the hospital, the insurance did not cover because im ok after the test!

what im not satisfied here?during the first procedure/registration normally, the hospital must call the insurance company for the checking whter can claim or not. but why after run all the test, the told me not cover

and still now, i just run back still not paid anything.im gonna report this to tribunal.

i need a solution/pendapt from u guys, what can i do now. 4.5k??i can pay , but not easily just give the money.

depends on your hosp got get the approval letter frm Insurance company B4 warding you .... if didnt, then sorry, cant claim....

yes, the hospital or doctor should informed and confirmed with you before you are admitted to the hospital on whether these are covered

try contacting your insurance agent and see what s/he says

are you sure you got GL before be admitted to Ampang Puteri?

Usually diagnosing procedure is not covered by any insurance unless it is confirmed later that the doctor found a problem.

Even the GL was issued, there is also subject to term and condition.

I got this problem when I hurt my knee while playing paintball and the doctor suspecting I tore my knee ligament and want me to undergo MRI scanning. In the admission form, he put to diagnose for knee injury. And my medical card at that time was MAA refuse to issue me a GL because it said for diagnosing. I took risk, pay by myself first, undergo MRI scanning and it was confirmed I tore my knee ligament. Then, MAA issued the GL.

You can try to file to tribunal but not sure you can win. Anyway, if there is nothing to lose, just give it a try. Who knows technically they are wrong and you can get back 4.5k

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Added on October 28, 2010, 11:40 pmUsually hospital or doctor will not bother if the procedure that he is going to do is covered or not. Their job is to treat you and be paid for the service. There are lots of medical plan out there and each of them is different.

What the hospital will care is what is your R&B limit and they will try find a room based on your entitlement.

When the insurance company issue a GL, they will specify the maximum amount that is covered. Usually the annual limit. If your bill is over the limit, the hospital will inform you. But sometimes not.

Other small condition, they will not care. Some medical plan only entitle one visit per day. But sometimes the doctor visit you twice. So, don't be surprise you need to pay the one visit by yourself. The doctor and hospital will not bother abt this.

It is always good before you be admitted, you inform your agent. He should assist you with this sort of problem. Please confirm with him if you are covered or not. Your agent should know better compare to hospital and doctor.

One lesson, if the doctor are unsure what is going on and want to do lots of testing/diagnosing, be prepared you may need to pay the bill by yourself.

This post has been edited by ajau: Oct 28 2010, 11:40 PM

sorry but if you're not sick the insurance wont cover the bill. it's that simple. the medical cards in malaysia dont pay for diagnostics unless you get diagnosed with something. foreign insurances would pay but i am not aware of a local one that would.

holy cow, sad to learn your case. Got med card and doctor confirmed you need to be hospitalized but still need to pay. Yah, go tribunal, nothing to loose.

Prudential agents: I have Prudential Med Card, would above also apply to my case if admitted to Sime Darby MEdical Center?

As long as you are not admitted only for diagnosing procedure, you should be covered.

bro, if not mistaken, hurting your knee while playing paintball is considered an accident. Hence, accidental treatment, whether hospitalized or not, IS COVERED....

are you using medical card? cashless facilities?

This is the standard procedure of medical claim :
(this is for G.E and I'm not very sure is it applied to all, but should be no much different)

1)Unfortunate Happen
>>>>>>>>> PLEASE INFORM ANY INSURANCE AGENT IF POSSIBLE

2)Admission
>>>>>>>>>Here policy holder and specialist will sign Admission Guarantee Letter

3) Hospital will fax application to insurance company
>>>>>>>> Here where initial decision will be made!
*if standard case(known situation/accident caused/emergency condition), GL will be issued and claimt should be no problem
**if not standard(unknown situation/diagnosis/new medical card), we may get declined of GL
(doesn't mean claim decline, but will be confirmed again with medical/specialist report)
~hospital will let patient know if GL declined > they may ask for deposit/payment
~G.E will inform agent if GL declined

4) SMS will be sent to agent and policy holder if approved

During discharge
1) hospital send i)Final Bill,ii) Itemised Bill & reports,iii) Discharge GL Form for G.E

2)G.E will issue
i) discharged GL
ii) Excess amount to be collected from patient
iii) SMS for agent and policy holder

3) Hospital collect excess $ from policy holder to discharge

There are EXCLUSIONS section in every policy, we should aware.
Hospitalization primarily for investigatory puposes, diagnosis, Xray eamination, General Physical or medical examinations, NOT incidental to treatment or diagnosis of a COVERED Disability...........

There are always clauses, so please inform agent(that why i always tell my clients to have few agents), any agent, we may could help.
Some doctors are aware about clauses, some don't.
Hence communication between agent and doctors are VITAL.

For your case, you may appeal actually, ask doctors to write a letter about "reason of hospitalization" if possible.
State your condition before/during admission and possible causes of it.

ONE IMPORTANT MESSAGE
Insurance Company DID NOT earn extra a dime from NOT paying claims, they earn from investment.
But what insurance companies' responsibility is to WELL-Manage the medical pool fund.
Appointed-underwriters will do decision either approved or not, and they don't get commissions for not paying a claim.
***Not to offense this thread but I'd think a lot of consumers did misunderstanding about claims***

This post has been edited by JerryTeh: Oct 31 2010, 11:46 PM

yes and i agree many people are not aware of this
some do not read even the policy when some things are explained very clearcut in the policy

are you stupid? it is in the best interests of the company that you do not have claims
i am suprised this shocking statement is coming from an insurance agent!!!
while all the insurance companies are regulated and are big
they should be proffesional and would not focus on intent to shortchange you by trying to avoid your claims by finding ways to void your claim
their reputation and service is more important to them

having said that, your statement that they do not earn a single dime sounds simply...
investments are investments, your life policy may be investment linked, that does not mean they can pay all the policy holders solely from your investments.

they primarily earn money from the same way traditional insurance companies do.

This post has been edited by amalthea: Nov 1 2010, 12:34 AM

hye guys, im sorry not able to replied every single response from you guys.

the latest news is the case is already bring to top mgmt for investigation, but still yet not get any news from them.


i will update the cases once resolved.

thank guys!

Ops, some misunderstanding here....

Of course they are business person and look for PROFIT
what i wanted to mean here is:
"they don't seek profit from not paying claims, but seek profit from the investment return of the premium pool-fund.

and this too


I hope at least you agree with this



This post has been edited by JerryTeh: Nov 4 2010, 04:48 PM

Claim tips

If any similar occasion happened,

please seek advice from agent and doctors.

Eg:

For this case, if there are "treatment" during the hospitalization, claim will be much easier,

"treatment" example will be "water dripping"

Sorry to hear that, but since you stay for 3 days 2 night, im sure there is a reason for the doctor to ask you to stay for that long (beware more and more hospital is practicing scamming tactic, meaning they ask you do a lot of scanning and stay so they can earn more money). Well, try get the doctor to write some essays and might able to get the claims .

Some useful information for those holding medical card.
Some insurance companies do appointed service agent for admission purposes. This company such as AAM or SOS. Those not assigned any service agent as such will strictly relies on the insurance agent or that particular in handling all hospital linked issues. I only explain those with AAM or SOS or ISOS services. This type of service have a wide range of panel hospital. The total amount of the panel hospitals tight with any insurance company are based on the service pay from them. That's why u notice some insurance company have more panel hospital and some dont. The standard procedure which with this services as below:-
During reception in any Panel hospital.
Reception will call up the contact number behind your medical card and ask information of the card holder. all these numbers are for above mentioned service agent. they provide 24 hours operation. then they will fax a requisition form to relevant hospital. then this form will pass to specific doctor which done the inspection to the patient. In this form will ask the opinion from a doctor about d patient's health condition, what treatment suggested and when do you think this problem occurs, how much it cost, how long to stay and signed by doctor. then this form is fax back to the service agent. there are doctors with these service agents. d doctors will go through the report and make decision. If they agreed with the treatment filled then will issue GL of cardholder which include d room and board limits, and annual limits and fax it to the hospital to process.
After all done, all bills will send to the service agent, then they will scan through the bill. Anything not relevant to the treatment will exclude in their GP letter to the hospital.
cash allowance will be handling differently.
This is the benefits with service agent.
this kind of service also offer international emegency evacution service.

hi, just want to share something that happen recently to my auntie when going to government hospital in putrajaya

her company insurance cover her (she work in private sector) so just want to share how to obtain GL and other process to whom that have similar cases

so here goes the process (if i recall correctly)
1.check with doctor then the doc said need to admit .
2.so she registered first, need to paid rm100 deposit (refundable)
and need to keep the original when claim back deposit.
3.admit to ward, call insurance call center then they said need to obtain admission letter from hospital
4. ask doctor to create admission letter (this letter created by the doctor), when got addmission letter send back to insurance company.
5. they verify and replied back with GL
6. when dischaged from ward, go to ground floor payment counter (close 9pm), give GL
7. when officer at payment counter said ok then can go home
8. before go home, go claim refund deposit back and bring original receipt , deposit counter only open 9am-4pm workdays only, if not able to visit on that time, visit later time also can

hope this help other people

On top of that, I want to stress again:
YOUR AGENT IS VERY IMPORTANT!!
Paying them service fee, you should call your agent to assist you.

I plan to change my medic card aia to hong leong msig
Hlmsig the benefit is premium is fixed..also coverage higher per year...only cover until age 70 compare aia till 100
As i know the challenge for medic card when to get GL.

So far review aia very good.
Anybody experienced using hlmsig?

Thank you for the info sharing. Very insightful!

This post has been edited by daniellehu: Oct 2 2021, 10:10 PM