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 Prudential vs Great Eastern: My Experience, Not all insurance companies are the same

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WaCKy-Angel
post Sep 5 2019, 02:28 PM

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Hi just to share my story also about GE.

They seems trying very hard to reject claims by using many excuses/reasons. But i was able to fight for it and won it after a few phone calls with their "supervisor".

Just FYI if they trying to be funny, just tell them u will report to OFS (Ombudsman for Financial Services) and BNM (Bank Negara Malaysia).
Their services are FREE u do not need to pay anything, they will help u to deal with the insurance company.
WaCKy-Angel
post Sep 5 2019, 02:32 PM

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QUOTE(wirelessdude @ Sep 5 2019, 02:07 PM)
user posted image

How many of us are actually given the opportunity to go through the entire document before we sign? It's the same in Malaysia for SPA, will, loan agreements, etc.
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What is the reason to exclude it? If Prudential accepts it then they should too.
Putting clauses does not means automatically win even client signed the papers.

If anything u can refer to OFS, ISM, and BNM.
WaCKy-Angel
post Sep 6 2019, 08:12 AM

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QUOTE(roystevenung @ Sep 5 2019, 04:04 PM)
I suspect the reason why Prudential paid and the other insurer rejected the claim is that your CI with Prudential is still on the old contract whereby key hole surgery is not mentioned in the heart bypass CI definition.

If you have the Prudential policy, you can snapshot it to confirm.

CI dispute happens a lot in the year 2000-2006 as there isnt a standardised CI definition. A claim in insurer A is approved but rejected by insurer B due to this.

This is why in 2005 (or 2006?) BNM gives a standardized list of CI to be implemented across the industry to avoid confusion.

You mentioned that you had also switch your son's policy to Pru, you may confirm that under the new definition for the heart bypass, keyhole surgery is not covered.

Yes I am a Prudential agent
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So what exactly is the reason it is now not accepted just because BNM specifically didnt mentioned about the new procedure?
What if there are newer procedure later? wait for BNM to state out too?


QUOTE(wirelessdude @ Sep 6 2019, 08:00 AM)
My two medical cards were purchased in 2004 and 2012 respectively.

I did not go for heart bypass. Mine's valve repair via keyhole surgery for mitral valve prolapse.

And that's precisely my point... how can you sell a policy that's supposed to last for 60 years but limit the methods used to out-dated treatments? The surgeon obviously chose keyhole surgery because it's the more advanced method. And acccording to my cardiologists, only 2 hospitals have such experienced surgeons - IJN and Universiti Hospital.

Should the insurance company ethically define the method used? They're after all an insurer and not medical consultants.

I bet most agents still sell critical illness cover as "we'll pay if you get any one of the 36 or 42 critical illnesses", right? They don't say "only after treatment and only if you used specific methods". If you disclosed this, do you think your customers will buy the insurance?
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Btw i was wondering how come didnt wait for GL approve before doing the procedure? If hospital did contact insurer im sure they will list out what are the procedures going to be done and insurer would reject it and hospital would have to inform you.
WaCKy-Angel
post Sep 6 2019, 01:39 PM

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QUOTE(Aurora Boreali @ Sep 6 2019, 12:11 PM)
His gripes are with the CI payout not the medical insurance.

If you read another post about that, keyhole was excluded circa 2006 from CI claims. Probably because if your illness can be cured via keyhole surgery then it's not "that" critical.
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I thought CI once diagnosed will payout d? regardless whether any medication/treatment is being done?
Isnt that how it works?
WaCKy-Angel
post Sep 6 2019, 03:44 PM

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QUOTE(WaCKy-Angel @ Sep 6 2019, 01:39 PM)
I thought CI once diagnosed will payout d? regardless whether any medication/treatment is being done?
Isnt that how it works?
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QUOTE(wirelessdude @ Sep 6 2019, 02:55 PM)
That's how we were all sold the policy but it's clearly not the case. Hence, the point of this post to create awareness.
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QUOTE(prophetjul @ Sep 6 2019, 03:04 PM)
Yeah

I do not recall anything about the method of treatment.
Once you are diagnosed, you can already apply for the funds. At least that was how they told us.
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unker roystevenung can advise?
WaCKy-Angel
post Sep 6 2019, 04:38 PM

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QUOTE(roystevenung @ Sep 6 2019, 04:29 PM)
There is a 30 days survival period for cancer and a min of 90 days if permanent Stroke (previously was 6 mths).

So it depends on what illness is being claim...
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Wow getting more technical already... i have no idea what that means.

So just recap again, so it does not means eligible payout once diagnosed with CI ?


Do u mean if diagnosed with cancer also will not pay out if still survive after 60 days?

This post has been edited by WaCKy-Angel: Sep 6 2019, 04:39 PM

 

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