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 Insurance Talk V7!, Your one stop Insurance Discussion

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lifebalance
post Aug 15 2021, 01:23 AM

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QUOTE(super911 @ Aug 15 2021, 01:04 AM)
I have checked with etiqa but they said the highest claimable amount is RM150K. Any idea which insurance company can fully cover RM300K?
*
Already mentioned the companies above.

Etiqa can only offer lower annual limit.

This post has been edited by lifebalance: Aug 15 2021, 01:24 AM
Leo the Lion
post Aug 15 2021, 10:25 AM

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QUOTE(delsoo @ Aug 14 2021, 11:39 AM)
No, la. I wont be so stupid haha. If I need to be hospitalised, I will come back to Msia lo tongue.gif Is that still possible ? the medical card still valid I am not in Msia for 90 days consecutively ?
*
What if you suddenly passed out and admitted to SG hospital? You can’t choose to move to Malaysia hospital
ping325
post Aug 15 2021, 11:06 AM

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QUOTE(super911 @ Aug 15 2021, 12:31 AM)
Recently there is a viral covid hospitalization charges over RM300K. Is there any medical card willing to cover this amount?
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bro...these are case to case basis....
let me share you a real life example....

Scenario 1 - real case of my friend in negeri sembilan
A close friend of mine get covid positive , he also have insurance plan with prudential.
when he admitted to hospital , doctor say he is just mild case nothing to worry about...just quarantine at home.
However, he is worried & insists want to be admitted, with self paying bills.
He is panic , worried it will escalate to stage 3/4 suddenly.

Well, of course doctor welcomed him, since he mentioned self pay.
THIS SCENARIO CANNOT CLAIM INSURANCE MEDICAL CARD.
He stays around 1 week and total bill around 60k.
Will the bill amount same when claim using medical card ?
Well, case to case basis, always bear in mind that certain portion of itemised item cannot be claim by medical card & medical card is used for necessary treatment basis only.

Scenario 2
Someone kena covid and private hospital say he need immediate treatment.
Then this is different case. Later on if the bill charged 200k , it can be claims by any insurer that covers covid.
Claim limit , claim terms , cashless or reimbursement is depend on respective insurer T&C.
Better to standby cash in case of emergency.

-------------------------------------------------------------------------------------------------------------------------------------------------------------------

Regarding the screenshot of the 300k bill that everyone shared on social media is very brief , we cant just judge the book by its cover.
It can be the customer pay himself or claim from medical card.
When it comes to medical card usage, it is subject to necessary treatment ONLY.

So back to your question : Is there any medical card willing to cover this amount?
For prudential , yes , subjected that is it necessary covid treatment & the covid promotion still ongoing.
*subjected to cashless or reimbursement basis
For other insurance company , you may check with respective LYN members other insurance brand. [ Not 100% portion of the bill can be claimed. ]

» Click to show Spoiler - click again to hide... «


This post has been edited by ping325: Aug 17 2021, 03:39 AM
lifebalance
post Aug 15 2021, 11:25 AM

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QUOTE(ping325 @ Aug 15 2021, 11:06 AM)
...

*
You could have just summarize into the statement below.

Can I submit a claim under this Campaign, if I am a Category 1 or 2 COVID-19 patient but I am asked to be hospitalised in a private hospital according to my doctor’s recommendation?
In general, for a COVID-19 patient with no symptoms (Category 1 - asymptomatic) or who does not require active treatment i.e. in quarantine only (Category 1 - asymptomatic or Category 2 - symptomatic, no pneumonia), any services received during such hospitalisation including quarantine at Quarantine centers, Quarantine at Hospitals or Home quarantine would not be deemed as Medically Necessary. Hence, the expenses incurred will not be reimbursed under this Campaign, unless there is evidence showing the hospitalisation and treatment received are Medically Necessary and active treatment is required for the patient during the hospitalisation.
super911
post Aug 15 2021, 12:56 PM

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So back to your question : Is there any medical card willing to cover this amount?
For prudential , yes , subjected that is it necessary covid treatment & the covid promotion still ongoing.
*subjected to cashless or reimbursement basis

So company can stop the covid promotion anytime?

ping325
post Aug 15 2021, 01:31 PM

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QUOTE(super911 @ Aug 15 2021, 12:56 PM)
So back to your question : Is there any medical card willing to cover this amount?
For prudential , yes , subjected that is it necessary covid treatment & the covid promotion still ongoing.
*subjected to cashless or reimbursement basis

So company can stop the covid promotion anytime?
*
unfortunately yes , they can pull back anytime
for prudential

This post has been edited by ping325: Aug 15 2021, 02:35 PM
lifebalance
post Aug 15 2021, 01:52 PM

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QUOTE(super911 @ Aug 15 2021, 12:56 PM)
So back to your question : Is there any medical card willing to cover this amount?
For prudential , yes , subjected that is it necessary covid treatment & the covid promotion still ongoing.
*subjected to cashless or reimbursement basis

So company can stop the covid promotion anytime?
*
Only AIA has no such T&C
JIUHWEI
post Aug 16 2021, 11:00 AM

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QUOTE(ping325 @ Aug 15 2021, 11:06 AM)
bro...these are case to case basis....
let me share you a real life example....

Scenario 1 - real case of my friend in negeri sembilan
A close friend of mine get covid positive , he also have insurance plan with prudential.
when he admitted to hospital , doctor say he is just mild case nothing to worry about...just quarantine at home.
but he die die want to be admitted , he say he pay himself he just want to make sure 100% treated.
He is panic and scared to die , he worried that his stage will escalate to stage 3 or 4.

Well, of course doctor welcome him , since he mentioned self pay.
THEREFORE , THIS SCENARIO CANNOT CLAIM INSURANCE ALREADY.
he just panic and dont want to die...
he stays around 1 week and total bill around 60k.
Will the bill amount same when claim using medical card ?  biggrin.gif

Scenario 2
Someone kena covid and private hospital say he need immediate treatment then different case.
later on the bill charged 200k , for this case can be claim by prudential as long as the covid coverage promotion still ongoing.
claim limit is according to the limit of medical card you bought.
whether it is cashless or reimbursement ? i advise standby cash first if suddenly cashless cannot use

-------------------------------------------------------------------------------------------------------------------------------------------------------------------

The screenshot of the 300k is very brief , we cant just judge the book by its cover.
it can be the customer pay himself and he want the best treatment and budget not an issue , so hospital charge gao gao full-fledged servicing.
when it comes to use medical card , it is subject to necessary treatment ONLY.

So back to your question : Is there any medical card willing to cover this amount?
For prudential , yes , subjected that is it necessary covid treatment & the covid promotion still ongoing.
*subjected to cashless or reimbursement basis

user posted image
*
The picture you uploaded...
That is the sub-total. As clearly stated in the picture that went viral and you chose to upload

The actual total is over 600k.
Yes, the person paid it himself. After all, he was hospitalized for close to 2 months consecutively.

Just for education sake, KKM has been playing an active role in managing and regulating ceiling prices that private hospitals can charge for whatever services or procedures. Should there be unreasonable charges, you can actually call up the hospital and have it reversed or refunded.
Your statements seem to undermine the ministry's efforts and also subject to libel and slander against KPJ Damansara Hospital (which my customers frequent and I have a good working relationship with members of its staff).

May I so humbly suggest (with your best interests at heart) that you either amend or remove your posting above.


mini orchard
post Aug 16 2021, 11:54 AM

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QUOTE(JIUHWEI @ Aug 16 2021, 11:00 AM)
The picture you uploaded...
That is the sub-total. As clearly stated in the picture that went viral and you chose to upload

The actual total is over 600k.
Yes, the person paid it himself. After all, he was hospitalized for close to 2 months consecutively.

Just for education sake, KKM has been playing an active role in managing and regulating ceiling prices that private hospitals can charge for whatever services or procedures. Should there be unreasonable charges, you can actually call up the hospital and have it reversed or refunded.
Your statements seem to undermine the ministry's efforts and also subject to libel and slander against KPJ Damansara Hospital (which my customers frequent and I have a good working relationship with members of its staff).

May I so humbly suggest (with your best interests at heart) that you either amend or remove your posting above.
*
How would a patient know the charges are not reasonable ?

Can a patient request for a review based on a 'similar' treatment of another hospital charges ?
lifebalance
post Aug 16 2021, 11:58 AM

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QUOTE(mini orchard @ Aug 16 2021, 11:54 AM)
How would a patient know the charges are not reasonable ?

Can a patient request for a review based on a 'similar' treatment of another hospital charges ?
*
PUTRAJAYA: A private hospital has been fined RM200,000 for selling three-ply face masks at above the ceiling price, the domestic trade and consumer affairs ministry said today.

In a statement, it said the compound was issued to the hospital for the offence committed under Section 11 of the Price Control and Anti-Profiteering Act 2011.

The hospital will be charged in court if it fails to pay the compound within the stipulated time.

The ministry conducted an inspection of the hospital on May 13 following a story which went viral of a patient who was allegedly charged RM201.60 for 18 three-ply masks used by the nurses.

This comes to RM11.20 apiece. The government’s ceiling price for three-ply face masks is RM1.50 each.

The ministry also seized several documents along with face masks of the same variety for further investigations.

“We are serious about ensuring that face masks are available at a price that does not exceed the maximum allowed,” it said.

https://www.freemalaysiatoday.com/category/...ced-face-masks/
JIUHWEI
post Aug 16 2021, 01:32 PM

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QUOTE(mini orchard @ Aug 16 2021, 11:54 AM)
How would a patient know the charges are not reasonable ?

Can a patient request for a review based on a 'similar' treatment of another hospital charges ?
*
If patient claim using medical insurance through the hospital, the insurance company (this is standard across all insurers) will have its own medical team to assess the itemized billing to ensure it makes sense before approving the guarantee letters. So patients won't have to worry about such issues.

If patient pay it themselves, the patient can check it with the hospital billing first before bringing it up to consumer rights groups.
It is not rare to have charges reduced, but they are done on a case-by-case basis.

Apart from that, some logic and common sense la.
For example an elderly female patient goes in for a knee surgery.
As part of the diagnosis, a pap-smear was done and charged to the patient.
Not logic la.

On top of that, should the patient make a claim on the insurance policy and there are items that were not payable or rejected, patient can query the hospital.
My team and I have made several successful attempts at reversing such charges over the years.




ckdenion
post Aug 16 2021, 03:06 PM

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QUOTE(JIUHWEI @ Aug 16 2021, 11:00 AM)
The picture you uploaded...
That is the sub-total. As clearly stated in the picture that went viral and you chose to upload

The actual total is over 600k.
Yes, the person paid it himself. After all, he was hospitalized for close to 2 months consecutively.

Just for education sake, KKM has been playing an active role in managing and regulating ceiling prices that private hospitals can charge for whatever services or procedures. Should there be unreasonable charges, you can actually call up the hospital and have it reversed or refunded.
Your statements seem to undermine the ministry's efforts and also subject to libel and slander against KPJ Damansara Hospital (which my customers frequent and I have a good working relationship with members of its staff).

May I so humbly suggest (with your best interests at heart) that you either amend or remove your posting above.
*
oh ya, is this really admission due to covid?
JIUHWEI
post Aug 16 2021, 03:21 PM

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QUOTE(ckdenion @ Aug 16 2021, 03:06 PM)
oh ya, is this really admission due to covid?
*
Yes it is.
Final total was RM603,XXX.83.


ckdenion
post Aug 16 2021, 03:36 PM

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QUOTE(JIUHWEI @ Aug 16 2021, 03:21 PM)
Yes it is.
Final total was RM603,XXX.83.
*
thanks for clarification. because i have friends telling me it is not due to covid. thanks to have someone to clarify this. thumbsup.gif
ping325
post Aug 16 2021, 04:44 PM

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QUOTE(JIUHWEI @ Aug 16 2021, 11:00 AM)
The picture you uploaded...
That is the sub-total. As clearly stated in the picture that went viral and you chose to upload

The actual total is over 600k.
Yes, the person paid it himself. After all, he was hospitalized for close to 2 months consecutively.

Just for education sake, KKM has been playing an active role in managing and regulating ceiling prices that private hospitals can charge for whatever services or procedures. Should there be unreasonable charges, you can actually call up the hospital and have it reversed or refunded.
Your statements seem to undermine the ministry's efforts and also subject to libel and slander against KPJ Damansara Hospital (which my customers frequent and I have a good working relationship with members of its staff).

May I so humbly suggest (with your best interests at heart) that you either amend or remove your posting above.
*
hi jiunwei , thanks for the heads up , i edited the post regarding the screenshot address to super911 post.

Very sorry , i didn't elaborate clearly and deep enough. Maybe i share my bill recently which i walked in to sunway velocity.
And also my friend who self paid for covid admission, billed 60k for 1 week stay. [ both self pay ]

During May 2021 ,I'm having a mild tonsillitis & i decided to walk in private hospital for treatment, i already know it is not covered under medical card.
I do not want to go to clinic and want a proper ENT specialist consultation.

Yes agreed that each of the itemised item billing is standard & according to KKM ceiling prices. Itemised charges also reasonable.
The difference is the doctor keep pushing me to add more itemised item during consultation, which will make the bill sky high if i didn't rejected.

Inside consultation , he did mention normal medication with one week rest at home will be ok normally , but i have to endure the pain.
Afterwards , he offered me if i want to treat it immediately by giving me more expensive pharmacy item + Tonsillectomy if i really don't want to endure the pain.
Is it medical necessary ? he says nop for now but it is best if I have budget for it to make sure everything 100% cured immediately.
The doctor actually show me all the itemised billing inside room from his pc, before i agree and consent to go for it.
The bill was like few hundred vs 20k...in the end i choose few hundred. If I'm a millionaire of course i would have go for 20k.

For my friend case, he don't have budget issue and want the best treatment for covid. Already pre-mentioned to the doctor.
Therefore, she almost ticked all itemised options including priority equipment usage , good meal and good solo room to stay.
She get billed for 60k ( non ICU stay , stage 2 ) for one week only. [Self pay-voluntarily admission]

» Click to show Spoiler - click again to hide... «


This post has been edited by ping325: Aug 17 2021, 03:45 AM
JIUHWEI
post Aug 16 2021, 05:46 PM

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QUOTE(ping325 @ Aug 16 2021, 04:44 PM)
hi jiunwei , thanks for the heads up , i edited the post regarding the screenshot address to super911 post.
-----------------------------------------------------------------------------------------------------------------------------------
Regarding my earlier post:
The screenshot of the 300k is very brief , we cant just judge the book by its cover.
it can be the customer pay himself and he want the best treatment and budget not an issue , so hospital charge gao gao full-fledged servicing.
when it comes to use medical card , it is subject to necessary treatment ONLY.

Modified post :
The screenshot of the 300k is very brief , we cant just judge the book by its cover.
it can be the customer pay himself and he want the best treatment and budget not an issue , so hospital charge gao gao full-fledged servicing with prior customer consent.
when it comes to use medical card , it is subject to necessary treatment ONLY.
-----------------------------------------------------------------------------------------------------------------------------------

Very sorry , i didn't elaborate clearly and deep enough. Maybe i share my bill recently which i walked in to sunway velocity.
And also my friend who self paid for covid admission , billed 60k for 1 week stay. [ both self pay ]

During May 2021 ,I'm having a mild tonsillitis & i decided to walk in private hospital for treatment, i already know it is not covered under medical card.
I do not want to go to clinic and want a proper ENT specialist consultation.

Yes agreed that each of the itemised item billing is standard & according to KKM ceiling prices. Itemised charges also reasonable.
The difference is the doctor keep pushing me to add more itemised item during consultation, which will make the bill sky high if i didn't rejected.

Inside consultation , he did mention normal medication with one week rest at home will be ok normally , but i have to endure the pain.
Afterwards , he offered me if i want to treat it immediately by giving me more expensive pharmacy item + Tonsillectomy if i really don't want to endure the pain.
Is it medical necessary ? he says nop for now but it is best if I have budget for it to make sure everything 100% cured immediately.
The doctor actually show me all the itemised billing inside room from his pc, before i agree and consent to go for it.
The bill was like few hundred vs 20k...in the end i choose few hundred. If I'm a millionaire of course i would have go for 20k.

For my friend case, he don't have budget issue and want the best treatment for covid. Already pre-mentioned to the doctor.
Therefore, she almost ticked all itemised options including priority equipment usage , good meal and good solo room to stay.
She get billed for 60k ( non ICU stay , stage 2 ) for one week only. [Self pay-voluntarily admission]

user posted image
Consultation is pretty much standard , the killing part is hospital charges where it can be added up until very long itemised which makes the bill very expensive.
*
My friend, the issue is not regarding consent but rather your smear campaign against private hospitals and the doctors working in said private medical facilities.

Yes, stronger medication and/or some procedures can cut short your recovery. It comes at a price too.
The doctor is giving you advice based on his profession, and the option is up to you. I believe the doctor's advice is quite fair from what you stated above.
It goes on to show how much our gov is subsidizing our general hospitals, considering foreigners take Malaysia as a healthcare tourism destination of choice!

I don't think we get to choose what items to consume in a hospital, other than maybe type of room and personal hygiene kit, etc. The necessary services are ordered by the doctors as well as the tools and venues required for whatever procedures/treatments to be carried out. I doubt we can anyhow tell the doctors and nurses which ones to omit.

Regarding Covid-19 admissions, I doubt there is any shared room in private hospitals for Covid-19 admissions, of any stage.

Again, my friend, I believe it is in your best interest to remove your posts smearing the good work that our friends and colleagues in the private medical practices are doing.
There has been so much progress away from the malpractice that you are implying, by both the ministry as well as private sector and their service providers.
To wipe out years and years of mutual effort and progress... I think it is quite unfair.



vl319
post Aug 16 2021, 11:13 PM

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Recently unable to get sms pin when want to login in to econnect GE. Anyone faces same problem?
tyenfei
post Aug 17 2021, 09:02 AM

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QUOTE(vl319 @ Aug 16 2021, 11:13 PM)
Recently unable to get sms pin when want to login in to econnect GE. Anyone faces same problem?
*
No problem "recently"

Latest login 9am no issue.

May be try restart your phone?
kok_pun
post Aug 17 2021, 11:07 AM

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QUOTE(vl319 @ Aug 16 2021, 11:13 PM)
Recently unable to get sms pin when want to login in to econnect GE. Anyone faces same problem?
*
Night time always like that one. Already feedback to improve on this. Morning normally work just fine
cybpsych
post Aug 18 2021, 01:24 PM

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HLA becomes third Malaysian insurer to provide COVID-19 coverage

The coverage is given at no extra cost as part of HLA’s complimentary special benefit for policyholders with individual medical plans when they get admitted at private hospitals for COVID-19 treatments in...

Categories 3 (symptomatic, pneumonia)
Category 4 (symptomatic, pneumonia, requiring supplemental oxygen)
Category 5 (critically-ill with multi-organ involvement).

“This programme also offers policyholders coverage for post-vaccination complication with daily hospitalisation benefit of RM200/day up to seven days for any complications that may arise after they are vaccinated,” noted HLA.

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