I am very frustrated and angry with Great Eastern Insurance Company.

A month ago, I brought my mother for treatment to Sime Darby Medical Center, as my mother was experiencing PR bleeding (bleeding when she goes to toilet) and stomach pain for 3 days continuously. The doctor has stated the illness as "Colitis", and has urged my mother to be admitted and undergo endoscope and other necessary treatments ASAP.

But, to my shock, Great Eastern has declined the admission Guarantee Letter (GL) . When I called their customer service asking for the reason, they were giving many reasons such as my mother is a new customer (11 months old), no sufficient information, they suspect this might a pre-existing illness and many more. After numerous phone calls, I was still not able to understand on what basis or exclusion term they have declined the guarantee letter. They are just guessing that it could be this or that or this, and based on that, they are declining me my benefits. When I asked them to justify and validate their speculation, they said they will need to investigate and that will take approx 2 to 3 months. How could a patient wait for 3 months? Are they out of their mind?

The next day I brought my mother to Selayang Gvt Hopt for treatment.

Then, I have submitted an formal written complaint to the insurance company, and they responded, giving me the same biased reasons, which I am not willing to accept. I feel cheated by this company and I have lost my trust in this company. They are giving many invalid reasons to deny GL for a genuine case. I have asked to terminate my mother's policy, and full refund of the premiums that I paid, but they resisted on that.


I am thinking of taking legal action against this company, if its posibble. Hence, I would like to get advice if the case can be fought in court, and what are the chances of winning.

Please help. I feel that this company is cheating me. Despite my mother being a medical insurance holder, I still had to bring her to government hosp where the waiting list for treatment is longer. They are taking my money, but not giving me what I deserve.They are not being fair. I want justice. Please advice.

Thank you.

Most insurance have a period where medical claims cant be made.Something like a probation cant remember the exact term. I am not sure about GE i think its 12 month. Did your agent not brief you about this?

12 mths is too long...I think should be 6 mths. You should file a formal complaint with Consumers Tribunal
tribunal

yes, check the policy to see any non-claim period.
if u wanna take action, file it to BNM and consult them first.

I feel sorry for your misfortune. However, I would suggest that you have your policy explained by your servicing agent again as not to jump to any conclusion.

Medical insurance has its own terms and conditions when it comes to medical protection. Coverage of a medical insurance policy depends on the premium (Higher premium for rare illnesses coverage) and also certain grace period for various illnesses/treatment (some with immediate effects, some would requires more than 3 and less than 12 months and some requires a minimum of 12 months).

Kindly turn to your agent for more information. You can also request to meet your agent's upline if your servicing agent is new to the industry.

Sincerely hope these little information helps to shade some lights to your unfortunate case. May your parent gets her treatment soon.

Hi thank you guys for the reply.

I have actually read the policy thoroughly after the incident.

According to the policy, the waiting period for the medical card to be fully functional is only 30 days. But I remember the agent however advised to wait until 6 months before using the card, and my case here is after 11months, and hence I feel that it shouldnt cause a problem at all.

The agent, at the time of admission, was out of country and I was unable to contact her. But later after she came back, I have called her and explained the situation. But she seems not really bothered about it, and she was giving all kind of excuses that she is not feeling well, hence she could not visit my house or the insurance office at the moment. Now I learnt the ugly truth, that some insurance agents are has two face, being nice when they ask us to sign up, but after tat they just ignored us. So please be extra careful when an insurance agent approach you, even when its your friend. Learn from me.

And actually, I have also submitted my complaint to BNM. But the officer at BNM hinted me that most of the time, the client will not get back the premium in cases like this. I was more upset when I heard this. It is very clear that the insurance is being unfair, giving thousands of reasons to decline the GL, yet the BNM officer still saying that like the GL is a value added service and its not a guarantee. Yes I agree, but shouldnt there be a good reason to decline the benefit? How can they can decline the benefit only based on their stupid assumptions. They didnt validate anything, its all only speculation.

This is why I am planning to sue the insurance company as my next step. Appreciate if anybody could point me in the right direction, to find a law firm with minimal consultation and legal fee. I just need my premium back. And to inform as much as people as I can, that Great Eastern Medical Insurance and their customer service sucks. My personal advice, please dont buy medical insurance from this company.

if u don't mind to tell us what's the monthly commitment?

Just reveal the agent name here..

Suggest u contact your agent's agency and look for the manager to help u out. Good luck

The premium that you have paid so far is less than 1 year, hence the damage done is not severe should you opt to surrender your policy. However, bare in mind that GE has never denied a coverage on your mum's case but placed the medical coverage on hold for 2 months or more, pending on investigation.

Should you were to terminate GE policy for now and engage an alternate insurance company for coverage, your mum may not obtained the coverage on "Colitis" illness in near future. GE policy is bought before your mum is diagnosed with Colitis, hence GE may likely to provide coverage after the investigation. If I am not mistaken, you may still make medical claim (partially or entirely) at a later stage.

Please consult an alternate GE servicing agent on this issue. FYI, you are able to transfer your insurance policy to the servicing agent that is able to help you in near future. Find out more information prior to making any decision.

Remember, the people whom you have contacted in GE earlier (besides your agent) has no intention of screwing you up. They are just employee who follows a standard operation procedure in addressing your call. I can understand that you are frustrated and have made up your mind to discontinue with the policy but your next action may caused your mum greater disadvantage in medical coverage should you proceed with your plan.

May your mum gets better in time.

not surprising, very common case happened to GE customers

Yes you are right that there is a Waiting Period for medical cards. The waiting period are 120 days for Specified Illness but "Colitis" isn't one of the Specified Illness, hence it should not apply.

Was the condition due to a pre-existing illness? Meaning that your mum had it (and most importantly had consulted a Doctor) prior to obtaining the medical card?

I understand Felix. Even the GE Officer mentioned the same thing, tat only the GL is declined, and not the claim. He even asked me to pay first and submit the bills for claim.

But is that why we are taking I insurance policy in the first place? I know I take medical insurance for my mother so that incase of emergency like this, she could get admitted in the hospital with no payment or minimal payment. Tat is the reason we are paying the premium. And tat is the attractive feature that all insurance agent mention to client, that when emergency happens, you might no have the money, and which is way medical card is important. My agent gave me the same crap as this and I bought it.

We are paying the premium not because we want the reimbursement, but we want coverage from the beginning of the admission. If reimbursement is wat insurance offer, I believe nobody will take insurance policy.

And the worst part is, they couldn't even give me a proper reason. My mother do not have a medical record related to Colotis, which I know for a fact, and the doctor also mentioned in the diagnosis form, that she I her professional opinion thinks that this is not a pre-existing illness. But the insurance keep giving the pre-existing illness shit and other stupid excuses.

I mean if they suspect this is a pre-existing illness or wat, investigate laa.. I don't stop them. But do it fast in a day it two like tat, not 2 or 3 months for god sake. Stupid insurance. Doesn't really care about their client.

Yes, totally agreed. Illness does not hold out on patient for 2-3 months, hence GE should expedite the investigation process. Do speak to your friend cum insurance agent again on this matter, and try to speak on a mild tone . She maybe new to this industry and does not possesses adequate knowledge to handle an emergency case like yours.

I am sure the last thing she wants is to deny any medical funding to your parent. Since this concerning your mum and time is not a luxury to you at this moment, you may want to ask her if she would prefer to have her upline with better knowledge and experience to attend to you.

sorry to hear about your situation..i understand you are going a difficult period. I just want to share another opinion which hopefully may benefit you.

I do have extensive coverage with Great Eastern as after my research, found it was one of the strongest insurance players in this region. Not to mentioned it is also supported by one of the strongest banks in the region (OCBC).

I know many people who have successfully claimed their medical bills/insurance payouts by GE. I think the agent plays an important role here as the middle person between the customer and the company. My suggestion is the same as felixwang has mentioned above, change the agent for better service and to resolve this issue in a quicker manner.

Great eastern is officially the largest, longest and voted the best serving insurance provider in the country. So in terms of insurance provider, you have made the right decision. However, you have unfortunately got a wrong agent. these kind of agents are everywhere, in every company and in every industry as well, not just insurance..

All the best to you in solving this issue.

where is ExpZero

he sell great eastern u can ask him

https://forum.lowyat.net/index.php?showtopi...&#entry66189024

ExpZero Summoning.... pls help?

Hi Kathi,

Sorry to hear your bad experience with Great Eastern. I'm one of the agents in Great Eastern and case like yours have happened several times to my mother and my clients for these past few years.

My mother case is similar to you where my mother had virginal bleeding at the age of 52(after menopause), the insurance bought 13 months ago and she is admitted to hospital. The GL was declined and the doctor suspected Cancer. After the investigation by doctor, the doctor has come out with a conclusion that it is non-cancerous and only cervical inflammation.

I have to run the errand to get the medical report for the reimbursement. The process of claim takes about 1.5month-3months because the insurance company will need to check for my mom's previous pre-existing record in government hospital, clinic surrounding my living area and medical lab report. The Turn-Around-Time for the hospital to get back to the insurance company is about 1month-2months. In the end, I'm able to get the reimbursement for RM12,000.

Last year, my mom has gone into hospital again, and the GL is approved immediately. If you need my help or advise on your claim, I'm happy to help you. I'd advise you to continue with your medical card from your previous agent as
1)Instead of getting back full refund, aren't got the claim will worth more money?
2)If you would like to change another insurance company, the waiting period will start all over again. The SOP of declining GL for less than 1 year for investigation purpose is standard in the industry as my ex-colleague who works in other insurance companies told me.

Rest assure, I'm an ex-staff and current agent of the company who works with claim and other departments for several years. This is Standard Operating Procedure(I believe for all the companies). If your claim is genuine, the insurance company can't decline your claim without justification after waiting period.

Thanks MNet
Thanks roystevenung

bro, if let say someone change/upgrade their medical card plan after 1 year, GE will still decline the GL for investigation purpose?

Hi Exp Zero,

Thank you for your reply. Really appreciate it.

But why the SOP is not being made aware to the client? It is never mentioned in the policy or by the agent that cases within 1 year time will require stupid 2 to 3 months investigation. Why it is never mentioned to the client? It is not even in GE policy. If they have mentioned that, I have made a better decision not taking this stupid insurance that do investigation for 2 to 3 months. This is a medical necessity and waiting for 3 months is really not rational at all.

And why I need to pay first when I'm having the medical card? I should be enjoying the GL benefit, unless there is a valid reason like for example my mother case falls into any of the exclusions. That I really can accept.

But now there any giving excuses like they are no sure, and there is not enough information. What in supposed to do if there is not enough information? I have forwarded all the documents given by the doctor. So now GE except clients to do research and find out information regarding the illness before admission to the hospital. What the hell? When they are selling, none of this were mentioned either by the agent or in the policy.

Really, based on my experience, GE is being unethical and biased. They don't really care about their client. Their so called SOP sucks, and client is not even made aware of that. Please don't choose GE, if you want your life really assured.

I really want to terminate my mom's and my policy with the company. Just tat I want my money back, but the stupid company dowaan to give back my money. I mean I never have claimed nything from them, so it is fair enough for me to get me back my money, but this the company said can't give. Blood suckers. Wants people money, but not giving them wat they deserve.