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

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.

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.

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.

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?

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.

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.

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

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

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.

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

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