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 pm

Usually 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.

Medical Card policies premium are never really "fixed" as there are bound to be repricing in between the years.

The rate of a person to get diseases are much higher >age 70 thus the reason why insurance company price it higher because you'll likely to make claims. It's recommended to have it somewhere up to age 80 as the current Malaysian age averages out around age 73 - 78.

It is a decision between steady payments and a potential giant shock.

Which would you prefer?

I just wish to help people get out of the conundrum of "is it worth it?"

From a risk management perspective, the real questions are:
"what is the potential impact of this risk if left unplugged?"
"can we afford to risk it?"

If we can afford to risk it, then sure, roll that dice.

If we can't afford to risk it, then how can we manage it?
- how can we minimize the risk?
- how can we prevent it?
- if all else fails, how can we transfer it?

In its essence, insurance is a risk transfer tool.