Medical card cannot claim if admit hospital without operation ?

Prudential agent can clarify ?

Cyst problem causing pain but doctor say no need operation.

This post has been edited by joey2000: Jan 15 2023, 01:53 PM

Go ask your agent deal for you la wtf. Of coz can claim if admitted

Claim your company staff medical insurance first.

Well since if the card tnc stated need operate only can claim then cincai ask doctor cut any parts out

The agent said got clause stated if no operation, cannot claim.

Baru ambil semalam, today admit?

The patient is jobless.

Few years policy.

Then suppose can la.. for pain management.. ovarian cyst?
Maybe u just got shitty agent..
GL not approve? Or that illness is existing illness prior from the date of policy?

Ask agent to show clause that say no operation cannot claim.

What the clause will usually say is if admitted to hospital for screening but no treatment then cannot claim.

You need to find the clause that the insurance company rejects your claim. Then talk to your doctor to see if he can write a report to say otherwise.

E.g. If insurance company say no treatment done during hospitalisation - then get the doctor to write a report that treatment was done but no operation was required, may using non-invasive treatment, by using medication, etc.

If the specific clause is some disease that the only logical/available treatment is surgical, then you're out of luck, because there are no treatment done without operation.

Try ask doctor there

...

This post has been edited by RiriRuruRara: Jan 15 2023, 02:07 PM

Already admitted, bill for 1 night is around 5k, and patient is jobless.

No GL because admitted at night. Not exist prior policy.

Painful only admitted hospital, not a screening. Don't know how the doctor write.

So scary after hearing that, sound like you must be very serious only can claim.

This post has been edited by joey2000: Jan 15 2023, 02:15 PM

Medical card suppose to be hassle free admission. Of course got limits, but generally should be usable.

Makes me worried..

Last time I use Zurich, few years ago.. no problem getting admitted.

Had to terminate because annual limit extremely low 50k.

Then I changed to Allianz.. so far haven't claim, but paying for 6 years already. This one expensive, because investment linked. I'll be frustrated if cannot claim. Agent also not responding anymore when want to ask stuff.

Not sure prubsn got this function or not but as far as i’m using etiqa, pmcare & aia, all having the function customer can request for GL by themselves
Which way faster than agent or hospital request it for u
That’s what i do now everytime go for antenatal checkup for my wife.
The SOP is easy, go seek referral letter from any gp clinic then upload the letter. For the next visit, just use the appointment date letter/text to request for the GL
In TS, something fishy bout it
As long as u admitted, usually confirm boleh claim

This post has been edited by AyamBannedTwice: Jan 15 2023, 02:18 PM

stay 1 night, can claim

if need operation only can claim
isn't that call medical insurance?

if medical card, even admit also can claim lah....WTF kind of medical "card" cannot claim if admit only

P/S : it's call "HOSPITALISATION"

This post has been edited by MR_alien: Jan 15 2023, 02:19 PM

Tell the doctor u want claim insurance.

They can hike up whatever issues and make claims possible.

Ask the admissions get GL.

Inb4 tak baca tnc

so it's not you la.. all heard from "friends"

Many outpatient can’t claim.

That’s why company insurance comes handy. For all outpatient claim lol

My medical card got no problem when admitted even though no operation. Different company.

Because the patient admitted at night. So no GL.

First time I heard this. Normally we think no problem claim using medical card.
Lucky I bought the different company and my agent is responsive.

if i meet up with an agent and the word "hospitalisation" keep popping up
and later i found out getting admitted isn't covered...i'm going to sucker punch my agent

Huh admitted at night no gl?

So you are the one who didnt do the job.
Go ask the registration counter regarding GL status, dah hantar ke belum? If dah hantar, go call the prudential regarding GL status.. aiyoo.. if under review, then ask la why..
Locum but dont know how to do the job..

Did you get reference letter in order ?

Hmm something really off here. Before admit, usually hospital will check & request for the GL first before assign her with room.
Which hospital is this?

What lapsap company and agent sell medical card that doesn't cover hospitalisation

If u sukak hati go admitted into hospital for no apparent reason then yes clear cut not covered because no medical necessity. But if doctor can proof treatment absolutely must be done during admission and not possible in outpatient setting then insurance will cover. Unless like someone said before this is some preexisting non-disclosure shit

get second opinion la. if pain affects your daily life then should remove. unless the risk is too high

i think is more like patient is stable, no need admit, because cant admit, cant claim.
ever wondered why many people said you cant depend on insurance company alone? most treatment and diagnostic procedure are done in outpatient term.
did people assume that most people that went for gonverment healthcare because they dont have insurance coverage?

This post has been edited by zerorating: Jan 15 2023, 02:53 PM

Yup, something is wrong!

Wtf ts something wrong with your story. Since when admit at night no GL??? GL can be issued anytime la

Out of office hour or weekends will only come up few hours or next day.

Pls learn the meaning of the word "admitted" ya

You can be admitted to hospital as an outpatient meaning you cannot claim any insurance as you are not staying overnight there.

You can also be admitted to hospital as an inpatient (hospitalsation) meaning u can claim your insurance as you will need to stay in hospital for a few nights.

If you are doing a treatment that does not require hospitalization, it means its not serious and you shouldnt be doing it at a hospital to begin with. Any GP clinic can do it for u.

If hospitalized, confirm can claim. Did you call Prudential directly or u just listen to ur agent? Sometimes agent give wrong info. U shud call the insurance company directly to clarify.

If no operation but he stays overnight in the hospital, confirm can claim for the medical fees and room charges.

And GL can be issued anytime. Insurance company got ppl working 24/7.

Btw, u shud state what insurance plan that he bought from PRU

This post has been edited by sexysarah1992: Jan 15 2023, 03:40 PM

Company insurance does not cover outpatient claim. If you go and see a gp clinic and claim from your company, your company is the one that pays the clinic later on.

All insurance does not cover outpatient claims. Only hospitalization is covered by insurance

They didn't get commission from you anymore.

I heard from some of the insurance agents they only get commission for 3-4 years something and then no more.

Probably your agent had move on and find a new customer to get commission. No longer want to service you.

Anything that Dr gives drip , confirm admission approved .

TS story seems many unknown and missing alot details.

Admit at night also can get GL. If Dr says need to admit, im pretty sure medical card covers it.

TS please get the full story first.
Even if ur fren admitted without using medical card, she can still claim it back

Admit more than 6 hours

If overnight..by right they should pay by day

for outpatient u have to pay first then claim back later, PRU medical card has this off limit claim of RM5k annually if not mistaken, if u didn't claim then it will add on to your total limit.

normal bro, most agents will disappear once sign up. There are only a few good ones out there. My agent also can't be reached..

Pru is the most strict claims la, deswai avoid 99

No GL from insurance provider, you proceed wad admission ? So you paid deposit?
Don't think medical card activation is dependent on surgery or not.

Suggest you check on dr report. Super agent also can't help you, insurance claim dept only reads dr report

What is your room&board eligibility?

Medical card is not one card flash all check all boxes.

To some may think insurance policy is medical card. Life insurance is not medical card

This post has been edited by jojolicia: Jan 15 2023, 04:19 PM

outpatient also you need certain forms to submit for approval right? If missing some forms like from dr won't get approve? Bcs if you need a form you have to get it while you at the hospital, if missing a form and to go back to the hospital for the form will be very difficult or even impossible bcs the dr won't entertain you? - is this true?

Dp

This post has been edited by jojolicia: Jan 15 2023, 04:15 PM

You sure its medical card and not life insurance and critical illness policy?

This post has been edited by jojolicia: Jan 15 2023, 04:17 PM

I have to ask the doctor to write an letter address to Prudential, the letter charge about RM50 for sunway hospital, the agent will up a form and then submit, the claim will be reimburse within a month. Documentation fee about RM150 unable to claim, the rest RM4k able to claim.

If u really want to claim without forking your own money, just admit in and then discharge, if u are outpatient definitely a lot of documentation require to claim it.

Thanks for the tip. So really hard to claim money for outpatient? Your client lucky you are still around and willing to help. I know some dr very bad temper would not entertain that request, even when asking medical question he get piss off...

What kind of nonsense u talking. GL can get at any time. Day or night doesn't matter. Its 24 hours iinm. Last time i request GL at 2am, by 4.30am its ready.

One more thing, for medical card normally got 2 types. One that cover outpatient & one that cover hospitalization. Most insurance providers covers only hospitalization. Those that offers both coverage very expensive worr.

wa bukan agent lah, this is my experience when i cut my finger during raya 5-6 years ago, so happen i was so panic and force to go nearest hospital to stitch it back. the bill was RM4k and it shock me

that suck man. I also spend rm1k for 4 stitches on forehead few month back. You lucky your dr was willing to entertain all your request.

Topkek. Cut finger only why need to go hospital? Lol. Any gp clinic can stitch it up for u for less than rm200

Not consider daycare if just 6 hours?

got inpatient?

I also cut my finger and went hospital. It was late night and many CCB clinics close early during MCO.

First day of hari raya, u think clinic ada buka?

What did the hospital do for one night no operation is 5k and what hospital is this?