I had good experience with Columbia Asia + AIA. Even though the doctor said during pre-surgery consultation that the procedure might not be covered (just try to submit for GL), it was approved and they paid the entire sum of surgery including post surgery care 60 days.
But agree it is unavoidable for private hospitals to mark up certain things when they know is under insurance. So far Columbia Asia is still reasonable based on my experience.

Ayam never had issues with insurance before, heck one of my hospitalisation actually the Dr sendiri sign as my guarantor and kasi discharge without paying deposit kek. One private hospital I kena pay deposit first but then fully covered later, and the other one had to pay full but fully paid back by insurance later.

I think the important points are in bold.

Somehow someone in the hospital wrote the report wrongly then screwed over the lady. First the insurance is going to ask whats the problem and whats the remedy. Insurance own doctor will look at the report and suggested treatment. If from diagnosis to treatment is not consistent, insurance will reject. That's why eventually the insurance do not cover.

Agree. The doctor need to provide the accurate details when requesting GL. And if there are things that might not be covered, the doctor need to inform the patient beforehand that they might need to fork out own money if the final amount is not settled by the insurance co (even though GL is approved).
That's what my doctor did.

Bingo

Your experience is about the same as mine, though mine doesn't involve surgery. Communication is most important when it comes to claims and that was what they did well. If they aren't sure something is claimable yet, they'll tell me up front.

Kkm seringgit kan ada
Owaii

Yah... I think I'll do the same next time if they ever rejects mine.

i think the one behind the PC and getting the GL has to be done properly, it may take awhile. like from 30min to hours if its lunch hour time.

and if report all good, it'll be fast fast and no additional cost incurred. sometime dunno what report they put in there, kena reject so many time lul

You need to hold the hospital accountable as well because they partially help you with the insurance process.

my customer paid for more than 10 yrs only realised the med card dont cover him when he is working overseas for the past 10yrs. he question the agent as the agent knew this. he had an accident and cant cover. luckily comp insurance paid.

Sebab boleh dik

That case already settled kan? AIA will deal with KPJ, kena decline because report not consistent, AIA claimed la

insurance is like this. they will try to reject whenever possible.
they will blame it on hereditary whenever possible.
so self need to be smart n fight back

I don’t know about KPJ but nowadays a lot of hospitals have staff dedicated to getting GL letter and doing insurance claims.

Insurance normally won’t reject claims after issuing GL unless the doctor reports mentioned something else.

The main reason why insurance companies got more strict with claims in recent years is due to rising medical cost. One of the reason is private hospitals used to admit people for whatever reasons especially when you have insurance even though it’s unnecessary and can be outpatient only.

As usual, 1 or 2 claims rejected and become viral, some people will say insurance are scams a lot of claims are paid out daily by insurance companies but nobody viral them.

Insurance don’t pay claims are usually down to documentation issues or it’s not covered in the first place or people do not disclose properly when they buy insurance.

Where you get such information? You work in claims before?

Not entirely...

Knn these insurance company will raise the medical card premium and why the fak u still reject the claims? Reason being medical cost increased? But why do want to increase customer medical card premium then?

acquaintance punya experience. altho its clearly not hereditary.
have to ask the doctor to write letter to fight back n prove which part is hereditary.
end up the insurance cannot prove, then claims finally approved.

u AIA protektor?

Dah bertahun tahun bayar premium tapi akhirnya tak boleh guna kan? Not included this and that. Not the first time. Just end the policy. They took your money to have full color centerspread in newspaper telling the world of their agent's achievements.

Wait till you are diagnosed with some disease which you think it's covered by the insurance but rejected because it's a sub variant / deviation of the main disease which has only been discovered yesterday.

This post has been edited by Capt. Marble: Jul 24 2024, 08:10 AM