Hi everyone, I have some inquiries regarding a medical card claim, I have a epidermal cyst removed via surgery last week.
Here's the story:
I have a lump on my leg since I was very young but I could not remember since when (the doctor put it 10 years old in my record, I am 31 now), the lump was small and was never diagnosed. I have been paying for my premiums only about 3 years+ , now does this mean it is a pre-existing condition and will not be covered?
The lumps only grew bigger recently and has sign of inflammatory so I decided seek medical help in a hospital, doctor advised to do a biopsy to figure out what it is, so I submitted an hospitalization admission, but the GL was declined due to "lack of report". Agent's advice is to pay for the biopsy myself, then apply the claim later, agent also implies that if the biopsy result states that the lump is not medical necessary, the claim will not be approved, as the treatment is consider "cosmetic" and will not be covered, which I understood completely.
Afraid of having to bear the whole medical AND hospitalization fee myself, I opt to not be hospitalized and proceed with the biopsy. Now here is where it becomes complicated, during the biopsy the doctor discovered that the lump is a cyst but cannot decide if it is harmful. Doctor said she's confident that she could remove the whole thing instead of a small part of it for the biopsy. She asked me if I want to proceed with the complete excision to which I answered yes, because no body want to go through this twice, I thought.
So at the end of the surgery, what could have costed RM500 end up costing about RM2000 and the whole cyst was sent for biopsy. 5 days later, the biopsy report came out, the doctor says it was medical necessary and I should be able to claim, because even though the cyst is benign(not cancer), it is inflamed and ruptured and could be harmful. But the thing is, I am not hospitalized! As in, I did not stay in a ward for a period of time!
So, here're my questions:
1. Again, is my condition considered "pre-existing"?
2. Is hospitalization/staying in a ward compulsory for the claim?
- Doctor says it is not necessary as this is under "day surgery".
- My agent insisted that I need to be warded in order to claim, but I have convinced to submit the documents anyway.
3. Is there any chance that my payment will be reimbursed? If there is, how long does it usually take?
Any help would be greatly appreciated, thanks in advance.
EDIT: Oh by the way, the insurer is Great Eastern.
1. Yes, I suspect that the reason for the declination of the GL is not because of the biopsy issue, but because you had "accidentally" mentioned that the lump had existed when you were 10yo to the Doctor during the GL application.
2. No, not necessary to be admitted if the medical condition can be treated as a day surgery. If the day surgery can be pre-planned (for eg, next week only do the surgery) the Doctor may also write in to apply for the GL.
3. However since the above case is clearly a pre existing, day surgery or not, the claims is most likely be rejected.
Generally if the claims are approved, it will be paid within 3 weeks upon submission of the relevant documents which may include:
1. Original Receipts
2. Tax invoices
3. Itemized bills
4. Medical reports or results of test (if any)
Oct 24 2016, 05:44 PM
Quote
0.1178sec
0.52
7 queries
GZIP Disabled