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 Medical Claim Procedure Problem :(

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leonard73
post Jul 24 2012, 12:18 AM

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Joined: Jul 2012
QUOTE(arm_audioslave @ Oct 28 2010, 06:34 PM)
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.
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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. hmm.gif

 

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