Thanks for the help, Yes,im getting the GL to confirm Prudential will reject or approve but they gave nothing until now. Next week we shall see. Its for full admission so i dont see an issues on that. IF THEY DIDNT REJECT MY OUTPATIENT TREATMENT/DAY SURGERY , i wont be posting here!

IM NOT HYPING, IM getting PUBLIC HELP/INFORM THEM TO CONFIRM OUTPATIENT TREATMENT for this PLUflexi MED Card is Cover or not, its so simple.. IF YOU CANT CONFIRM IT WITH BLACK AND WHITE, Its just TALKING only.. whats different with AGENT THAT SAY ALMOST EVERYTHING IS COVER WHEN We are BUYING IT. Dont FOOL US please. POLICY BOOK Stated clear its COVER and now emergency calling HOTLINE and AGENT SAY ITS NOT COVER. PAY YOURSELF FIRST



This post has been edited by max880930: Mar 2 2019, 03:18 PM

To know the status the GL is very easy.

Once the hospital has provided the necessary info, you can ask your agent to call the H&S 24 Hours hotline (not the Customer Service No) on this. This service is avaliable 24/7 to agents.

I have confirmed to you that Day Surgery works as stated in my earlier post. A GL request is still required for Day Surgery.

Great seeing how @roystevenung handle this. Not easy.

SIR, i dont need yours or AGENT confirmation cause its USELESS. What i need is PRUDENTIAL Confirmation letter with title head IF YOU HAVE HANDLE ANY DAY SURGERY/OUTPATIENT TREATMENT CASE For PruFlexi MED Before SO I CAN SHOW the agent and customer service how its been done.


Telephone recording on OUTPATIENT TREATMENT NOT COVERED unless accident PHONE RECORDING

https://youtu.be/WWN5xCBNhDk

ADMISSION = FULL Admission ( STAY IN HOSPITAL)

Outpatient treatment/DAY Surgery = RAI 131



This post has been edited by max880930: Mar 2 2019, 04:57 PM

I am as well disappointed with Prudential handling on my claim.

Bought a premium with them on last year 2018 April.
Submitted a minor cyst removal day care surgical claim in around Nov 2018

They straight decline, saying investigation is needed due to one year grace period from purchase date

Fine.

After that my agent called and questioned me: "Prudential investigation suspecting you have several months medical leave applied in year 2018"

I was like WTF? 😠
Since when I applied for such long medical leave? Such clueless accusation?

It made me straight felt that Prudential can make out any story just to try their best in rejecting your claim.
But i was suspecting if my agent making out the story on her own, so I straight emailed to Prudential on this matter.

Their customer service called but her call is totally impotent.

I was asking her:
1) Is this accusation really comes from Prudential? or it is plainly my agent's bullshit?
2) if former, then what is the source of this record? I think I have the right to know to followup with this.

She can't give any informative helps or facts at all, just keep saying the investigation records is confidential, source is confidential, blablabla, and she can't even confirm question (1), let alone question (2).

She just keep on accents that, "this is SOP (do i care?), and next time claim wont happen, and since you don't need surgery anymore (the cyst bursts before surgery day and I have just gone for normal clinics for wound cleansing), maybe we can close this case?"

I was quite rage at that time, my agent can't give any fact, even Prudential also can't give any fact.
And now i made a complain, and you are just trying your best to close the case?
How about the accusation? it is really valid? does it leave a defect in my premium record?
Dunno, my agent dunno, prudential also dunno, yeah, god knows
Such WOW

Before closing the calls, I told prudential CS
1) I will talk with my company to provide docs and statement to prove that I have NEVER applied for such long medical leave. no such bullshit.
2) I want to know the source of such accusation.
3) After investigation, i want a declaration letter from Prudential, confirming me that such false accusation will not leave in my premium record and affecting my future interest in future claim.

Just got the docs from my HR and sent to Prudential yesterday
So far still not resolved yet the matter, but such unpleasant experience and unprofessional issue handling attitude from such well-known insurance company. LEL

With others experience as well, I guess I made a mistake purchasing premium from Prudential.
Wouldn't recommended my fren to go for Prudential

-dupe-

This post has been edited by tadashi987: Mar 2 2019, 06:29 PM

For your information the application for the GL (irrespective of whether it is Day Surgery Benefit or normal admission) is between the Doctor and the H&S claims PIC. Whatever that is written in the application for GL will not be made available to the agent. Therefore I am unable to provide you with the said letter. Sorry.

During the application of the GL, if the case is able to be covered under Day Surgery, but the Doctor had requested that hospital admission is required, the H&S will ask the Dr to justify the reason why the admission is necessary.

If the Doctor is able to justify, then the admission will be granted, otherwise a Day Surgery needs to be performed. If admission it means incurring the Room, food and lodging, in hospital facilities, therefore increase the cost.

After the discharge from the hospital (irrespective of whether it is done via Day Surgery or stayed up to 2 weeks at the hospital) Pre-Hospitalization & Post-Hospitalization when submitting the claim form (see the claim form in my previous post, there is a TICK for Day Surgery Benefit), if the procedure is done as a Day Surgery, the agent will select Day Surgery Claim instead of Hospitalization.

Note:
The procedure for applying for the GL for Day Surgery & Normal Admission is the same. The only difference is that Day Surgery, you get treated and go back on the same day, whereas admission is staying at the hospital for more than 1 day.

The outpatient treatment the customer service has mentioned, it is for admission and claim under the POST hospitalization. She did not mention that PruFlexi Med does not cover Day Surgery?

That is why she advise you to apply for GL and if it is coverable, then the H&S will process the application under normal admission or under Day Surgery.

Please note that the deferment of the Day Surgery does not mean that the claim is rejected. It means they need more time to investigate the case.

In this case if the surgery had been performed (pay and claim) one may submit the claim for consideration. I noted below that you mentioned that the cyst burst before the surgery. See below

Frankly I doubt that investigation by Prudential reveals you had taken several months medical leave. Even if they had call your HR, don't you think that your HR will also ask your permission before releasing such information to someone who 'claims' they are from Prudential?

Even if you take medical leave (not saying that you did), it does NOT necessarily mean it was for the cyst, that means there is no proof that the Cyst was a pre-existing medical condition.

You may call the 24/7 H&S to really understand why it was deferred. They are the ones that handles the admission/claims. PM me if your agent does not have the number. Sorry as I am unable to share this no in open forum, otherwise the H&S will be busy with calls that is supposed to go to our CS.

Do you know that you can still file a claim under the Day Surgery benefit for the wound cleansing normal clinic bill? The thing about Cyst is that even after cleaning the wound, it can reoccur. Therefore multiple visits to the clinic may also be required.

However, since there is no GL issuance (meaning Pru doesn't have any record of the case), the Doctor that treated you needs to fill up the Doctors Statement . See my earlier post for the link.

By submitting the claim, then you know for sure for sure (yes its typed twice!) whether the case is declined or accepted for reimbursement basis.

P/S: I had also just help someone (not my client) to claim for abscess removal at the clinic, which was claim under Day Surgery (though his medical card is like 15 years ago PMM3).

The abscess removal at the clinic costs RM400 but unfortunately the Doctor charge RM60 just to write on that Doctors Statement. The medical report if not claim under GL has to be paid by client. He was only reimbursed RM360

TBH, a lot of things even us agents are unable to get our hands on, including the communication of the GL issuance by the Dr & the insurer.

OK i will pm you, frankly I really appreciate your help, even last time in another post I was asking a lot questions as well, but you do take time to clarify.

Too bad not all agents like you, same as mine, not much help I got from her, she didn't provide any helpful advise at all

**The outpatient treatment the customer service has mentioned, it is for admission and claim under the POST hospitalization. She did not mention that PruFlexi Med does not cover Day Surgery?**

I Deleted the front part which to verify my ic,policy number and plan. and YES She CONFIRMED MY PLAN, PRUFLEXI MED NOT COVER DAY SURGEY.

The Customer Service KNOW EXACTLY What is RAI 131 thats why he mention is outpatient treatment/DAY SURGERY

Here's the video of RAI 131 treatment.. just eat the radioactive pill and you can back home enjoy movie... which why government do it as DAY SUREGERY/OUTPATIENT TREATMENT.

Radioactive Iodine Treatment - I-131RAI 131 LINK
https://www.youtube.com/watch?v=Dfm8viittrQ




SOOOOOooo after you watch this movie how RAI 131 been done.

Dont you think its STUPID THAT I NEED TO DO FULL ADMISSION and STAY IN BORING HOSPITAL FOR FUN FEW DAYS?! IM DOING FULL ADMISSION NOW BECAUSE PRUDENTIAL REJECTED MY OUTPATIENT TREATMENT! i CANT EVEN GET ANY REJECTION LETTER TO PUT HERE. SMART right THEM?!

**Take note, this is not some normal public available pill. its radioactive pill that only nuclear department have it. so i have to go Panel hospital that have this SUNWAY,PRINCE COURT..** came out all this RUBBISH OutPatient treatment not cover. At This moment only i know how bad is Prudential..

OLD PRUDENTIAL CUSTOMER BEWARE..YOUR AGENT IS NOT TELLING YOU THE TRUTH/ SOME STILL THOUGHT IT COVER .. i confirmed with few agent, this plan DO NOT COVER DAY SURGERY/OUTPATIENT TREATMENT.. IF YOU FAINT..YOU CANT GO HOSPITAL PEACEFULLY CAUSE THEY WILL CHARGE YOU UNLESS YOU STAY ONE NIGHT HAHA..



This post has been edited by max880930: Mar 3 2019, 03:54 AM

The part that verify your IC/Policy No is in front. Please also include the recording whereby the CS says that PruFlexi Med is not covered for Day Surgery so that I may feedback to Prudential as it is already mentioned in the policy book that Day Surgery is covered.

The CS had also mentioned to you that you need to be admitted OR claim it as Day Surgery. Either way, the Panel Doctor will need to write in to request for the Guarantee Letter if you do not want to pay and file claim.

Once the Dr had write in with the GL request, if the case can be done as a Day Surgery the H&S will suggest to the Dr to do it under Day Surgery where you get treated and go back the same day, there is no need to be admitted.

The Day Surgery works with PruFlexi Med at the panel hospital or non-panel hospital. The only difference is that if you get the Day Surgery done at a non-panel, you need to pay and claim.

BTW, if a person fainted, definitely an admission is required as Doctors will need to run several test to determine the root cause. You can't expect that to be done as an out-patient.

Uh...told yah if day surgery or outpatient can be done, I don't need to be admitted at panel, even I'm paying myself up to now. ..

I will do a clear recording again since Saturday and Sunday prudential NOT open lolz.. why not you call and ask then show us the recording prove Here since you agent have special call line.

I have stated a few times on how the PruFlexi Med Day Surgery works at non-panel and panel, please read my post again.

Please just ask "Does Pruflexi Med Cover Day Surgery? Yes or No?". Do not ask any other questions please. Thanks

Now the tele customer finally on defensive.... YES they say its Cover BUT...xxx.xx..xxxx.. I Guess posting here is very efficient. Finally after 4 days trip to go&back hospital settled my Pre-admission..Between its FULL ADMISSION since my Day Surgery/outpatient treatment was Rejected last week Due to Inexperience Prudential Tele-operator/AGENT/Hospital & AMBASSADOR 3 SIDE?! I was forced to do full admission after drama of deferment letter by them and have to pay myself to get admitted.

Anyhow Finally Today AFTER 2 Weeks we can confirm DAY Surgery is Cover *with terms . STILL, i cant get any letter to confirm this.

IF you see the policy book WRITTEN Clear that OUTPATIENT TREATMENT IS COVER and DAY Surgery is one of its but they still denied it two weeks back. So..now its DAY SURGERY is COVER, but not OUTPATIENT TREATMENT?? lolz

Outpatient not cover unless accident recording with customer service..i do mention RAI 131 TREATMENT and immediately he say this is outpatient treatment.

https://youtu.be/WWN5xCBNhDk

Hope this posting will be reference for others in future incase prudential drama again..



This post has been edited by max880930: Mar 5 2019, 03:26 PM

my simple understanding on the summary of benefits table provided is. Day Surgery (which is considered as outpatient treatment in this case) is covered but the stated outpatient treatment is reimbursement basis.

Then the Customer service should say its COVER but you need to be pay first and reimburse so simple.. then i dont need to waste my time do FULL admission..go different panel hospital for 4 days+ 2 Weeks delay to find that nuclear facility.

EVEN AGENT AND HOSPITAL AMBASSADOR CONFIRMED my card cannot be used for Outpatient treatment/Day surgery.. IF They say CAN COVER/Reimburse, i will have done it at Government hospital UM Hospital since they have the facility there..AND I WONT BE POSTING HERE TO WARN OTHERS.

Outpatient treatment not COVER recording.
https://youtu.be/WWN5xCBNhDk

Between, i checked with few prudential agent with at least 8 years selling prudential.. ONLY MR Roystevenung here say its cover.. others Agent say NO for old card... SO..whats happening with Prudential?

Between, the agent i subscribed is my family member,she did confirmed many many times with their superior/prudential hq Its not cover initially and after i posting here only they/Prudential U Turn now.

yea thats what i understand from the picture you provided. outpatient (reimbursement basis - pay first claim later) day surgery (since the one you went through is confirmed day surgery), then yea it is claimable but not using the medical card (cashless/GL issuance).

btw whats the final outcome? dont worry so long got ppl is here to support you

Currently doing full admission at panel hospital. Should consider settled temporary since GL issued for Pre-admission. **accoding to agent** super hassle for this small ..day surgery/outpatient treatment. Lucky have some money in hand to pay for the admission and rechecking procedure.(RM2k+) If they told me can be cover&reimburse early on I will do it at government hospital private wing.. now had Transfered out and total zero record since government don't give acces to their blood test system. Hope panel is good. Going stay in to enjoy 1 week holiday lolz..

speedy recovery! hope there is no more further frustration there. anyway shouldnt be a problem la. at least got roy to support you here.

hi, anyone knows if prufleximed covers pre and post hospitalization for day care surgery? Called up customer service but she kept saying 'depending on dr' . Sigh..... The policy only states pre and post for 'admission' but doesnt specify . Agent has resigned. Any replies from the experts would be appreciated. Tq