I was having lunch with colleagues on the other day.

One of them complained about an insurance medical claim

went to do a Guarantee Letter on a medical situation.

then went to hospital, doctor prescribed Medicine A and B.

So the colleague asked the hospital GL can claim both medicine A and B ?

The cashier and pharmacy say can.

Then colleague took back the medicine and consumed all, didn't need to pay.

3 months later, hospital staff call my colleague, said the insurance rejected medicine B but medicine A is ok.

Requested my colleague to pay RM 150 for Medicine B.

My colleague maki hamun the hospital not happy with bad service as their cashier checked with insurance GL say ok.

So what would you do if you are in the colleague shoes?

A) Pay the 150
B) Don't bother la, ignore don't pay and never go back to that hospital.
C) write Complain letter and fight for credit note.

What would the pharmacist or the cashier know about whether this item or that item is claimable under insurance? That's insurance punya pasal. If TS' friend wants to make noise, he should go ask his insurance agent or his office HR.

colleague said the hospital cashier called the insurance co, and confirmed can claim.

You know what they say right? If it ain't in writing, it didn't happen (this is the original saying, now we just say "no video, no talk").

yeah but how to record the cashier say that?

but fact is then why hospital let my colleague go without paying? means they r confident GL can cover.

which makes me concern.

if next time I thinking my insurance can cover a big expensive operation.

mana tau? 3-6 months later suddenly hospital call to chase bill because say insurance not cover?

I suppose this happens often in the medical fraternity?

Actually, not really in Singapore.

A lot of what I do is online - and pre-approved LOG as my practice is linked to the national insurance schemes and the major insurance providers. The claimables are very strict. Any surgical tables need to be written clearly, any additionals are clearly listed and itemized, and any medications are issued pursuant to the condition that I'm treating. Experimental drugs (eg certain cancer drugs etc) are not included unless authorized prior, and the whole process is transparent.

Any item that is not clearly listed in the insurance coverage is paid for by the patient. The receipt is then given, usually with a supporting memo & an excerpt of the patient's medical records, and this helps facilitate the claims done by the patient against his own insurance coverage.

It's quite straightforward. None of my nurses will "call up the insurance" for confirmation - it's all online.

Good hospital staff will know which medicine is claimable and not, they will explain to you why the non-claimable one is recommended so then you decide whether you really need it or not. TS what drug is not claimable anyway?

Which hosp ur friend go lar? Usually pharmacist section doesn't know can claim or not. Not their job

Spot on. It's not their job, and neither is it the cashier's.

Should have asked your agent to confirm with the company underwriter.
As others said, not the job of the pharmacist nor the hospital. Hospitals can claim whatever from the insurance company but ultimately, it's the insurance company that is approving and pay out the claims.

This is Malaysia bro , very normal for them to call insurance company to ask . Every thing in Mal is not transparent ..

Yr case is nothing I kena with Sunway hospital . A can claim B also can claim , but doctor did A+B at one go hence cannot claim for B .

By any chance med B is antidepressants, for issomia, anxiety etc?

Company staff insurance?

This post has been edited by jojolicia: May 4 2024, 06:11 PM

is TS or friend?

Rm150 jer
If biforti I can understand the pain

exactly

What insurance company..?

If thats the case, wouldn't take long for hospitals to go bankrupt. Do expensive procedures, let customers take home expensive medication. Later insurance tak mau cover and customer MIA how?

2024 and here still need to call up insurance to check whether claimable or not, cannot brain.

Im beginning to think they purposely dun want to come out with a comprehensive list of medicines tat are claimable or not to have gray areas so to reject claims up to their discretion.

Welcome to merehsia......

As for TS question, just pay and get it over with.
Not worth the hassle to fight this one.

This post has been edited by COOLPINK: May 4 2024, 08:40 PM

That’s why I said in where I work, it’s clearly written in advance.

I have a recent experience:
Was warded due to vertigo. Upon discharge the doctor prescribed some medication. Months later the hospital claim the Insurance not paying for certain medication due to: it is not in the Doctor's report.
My argument is that how would I know if the Dr did not write this in his report, Afterall, the prescription was from the Dr.
Tried to avoid paying and argue about this with their accounts department. Ended up I received a lawyer letter demanding payment. So last , last I also end up paying. I am in no position and cannot afford a lawyer for this.

Policies/standards in a different country are not exactly relevant to what TS is asking, is it? His experience isn't an isolated case here in Malaysia.

My company is covered by HealthMetrics. Last year I went to a panel, they prescribed some medication. Took and left as usual. The next time I went, the clinic informed me that Healthmetrics left a note under my account, stating some of the medication previously given was not covered. I think the amount was about RM100-ish. Since the amount was relatively small, I just paid.

But if the amount was big, I probably would have insisted that the clinic take responsibility for it.

Fair comment, but I was asked by TS about how the system works where I work, so asked and answered.

I find in Msia really sucks.

Even for me, after going to hospital, I don't get any surgical table written sheet or what is claimable medicine or treatment clearly written in the bill.

How much was it?

Anything below 50k, good luck to them trying to get the money from you.

U don't sign the JDS, court can't enforce it on you.

THe cost of court case > the amt claim, most companies won't pursue.

lawyer letter just a scare tactic.

I would laugh if the hospital issue lawyer letter over a hundred ringgit bill.

Don't know, colleague didn't say.

for tS reference

Surgical tables are what we claim from the insurance. It’s what we are allowed to charge. You won’t see that in your bill.

wish at least can see a status in the bill

1) how much confirmed claim from insurance
2) how much still waiting for insurance to confirm

I think it is only fair to the customers

You will get a bill, but the bill may not necessarily show the codes and nomenclature we use to submit our claims for surgery performed.

Eg. In your bill, you may have a statement stating “surgical removal of malignant tumour of the upper limb with wide margin excisional biopsy” but the corresponding table is actually a 5A.

This post has been edited by hksgmy: May 4 2024, 10:22 PM

Life/health important or cash or insurance claim more important?

This is something that I cannot brain sometimes….

so in singapore can see or not, whether insurance claimable?

the colleague case one not life and death

Over the phone semua bleh.
When making claim, this one can not, that one also cannot. In the end, semua x bleh..everything depend on their understanding of the policy.

This post has been edited by Zhik: May 5 2024, 12:22 AM

Insurance and private hospital are not your friend.
My last trip for appendicitis removal, I got to wait until my appendix burst and rush into op room. 1 or 2 day stay become 7 days all because of a late GL from insurance.

My take - - > life is more important than to worry about a small medicine bill that you have to pay. If its a small sum, just pay and move on. My last visit cost be a whopping 20k++ & regardless how I hate insurance comp, without it will be dent to my wallet (over the last 5 years I have been in and out of hosp 3 times, a total of RM75k.
Learn from that, and move on.