https://x.com/surayaror/status/1815329794760040826

i dulu kena few times aready...hence now no more insuran liao...

due to ride mr3?
cerita la sikit...

ni yang seram nak ambil insurans

Be your own insurer. Don't buy......

no la...it was over more ten 10 years ago punya cerita


in short

when do claim .rejected...this not inculede that not included etc stoli

insurance is a farkiin scam... better for one to collect emergency money up to 500k-1mil... for any issues that miight ariise...

but if you're B40... no choice... you're at their mercy...

Both Insurance companies and Private Hospitals are dicks. The former will lure u with fake sweet promises of easy claims and a fake sense of security just so that you will buy from them, and the latter will markup and overcharge your bills with all sorts of unnecessary tests and medicines when they know you are paying through insurance. Insurance companies will then react by tightening claims with stringent T&C's, then a neverending cycle of wayang between these 2 money making cocksucking of a fuck companies. In the end, we are the ones that kena game by them.

Itulah sebab we should stop relying on insurance. Masa muda tu kerja kuat, jimat cermat simpan duit dan belajar buat investment. That money in our bank account is much much more reliable compared to insurance

If you pay first and then claim, can be quite difficult to claim

However if you get guarantee letter first, and hospital pandai buat kerja, then normally no problem. This AIA case already settled, and its because the report from KPJ was not consistent that's why rejected.

Insurance is still useful, you save money also no guarantee that the amount you save will be enough to cover the unforeseen medical costs.

'treatment can be done as outpatient'
yup, been there. who the hell last time people said demam sikit pon boleh diwad kat hospital?

this is one of the reason i prefer public hospital, no GL rejection bullshit.
and still been able to get abit of diagnostic work and treatment too despite of cheap rm1 fee.

last time i get outpatient consultation GL from my work insurance company, GL issue take near to 2hours, i just follow advise from hospital to got meet doctor with risk need to self pay first. when collect ubat, eyedrop tak cover, need to pay. but im impressed with that hospital pharmacy ask if want to take medication from the hospital or want to buy outside because hospital wan is more expensive.

This post has been edited by zerorating: Jul 24 2024, 04:03 AM

and no guareetee you will get help from insurance company either. myself i take insurance despite lack of trusts, but i focused my effort on saving much more. now my saving(not included illiquid assets) can cover 3 times of those insurance yearly cap(6 figure only)

This post has been edited by zerorating: Jul 24 2024, 04:07 AM

post #2 will help, they're governed under BNM..they're not free to do whatever they want

Not the first time hear about masuk one dignosis then keluar ++ a few more...especially KPJ...

Rm19k is not much. Wonder why they(aia) dont pay.

This post has been edited by forgotoldlogin: Jul 24 2024, 11:15 AM

thn what's the purpose of people paying the medical card for?

I mean AIA. Wonder why AIA declined.

I read the entire update on X. It was wise of them to kick up a fuss and viral this case out to garner attention. There are plenty of people out there who will blindly accept what insurer say and just fork out from their own pocket even though it’s the insurer’s role.

T20 spotted

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

Cerita say AIA argue can be treated as pesakit luar, and no need hospitalization

Doctors argue need hospitalization

if they wan to play, they can dispute almost anything under the sun

why this med and not that med?
why surgery when can use other techniques?
etc etc

end up those paying for insurance suffer more than they shud

TBH, i agree that insurance is kinda scam

we take insurance to help us in the future, but what for if got additional clause (Exclude pre-existing condition).. then no point dy taking insurance liao

lagi2 now their premium getting more expensive from paying 180, now became 270 (sudah 3-4x update price)

last time, my father got admitted at oversea hospital, already take travel insurance but because he got pre-existing condition, insurance die2 rejected the claim despite the diagnosis not entirely related to his case.

they are not even trying to help the client or anything, just straight declined the claim.

best policy for eternal coverage - don't get into any major accident or chronic health issue

for we know this......not referring to the insurance co - this is a given

the Medical fraternity - this one.....once you kena sangkut - make sure fat wallet, pray insurance will take care, company cover, or some form of safety net .........for when they come, they'll come with guns blazing to drain you dry

stay safe

The normal practice is private hospital will do as many unnecessary diagnostics as possible like MRI, CT Scan, Dexa Scan, X-Ray, etc. I guess any doctor that can extract the most money from insurance will get more bonus.

On the insurance side, any person that is able to minimize outflow of money will get special bonus.

Got doctor in private hospital that reject patients who will claim from insurance and only entertain patience that will pay with own money

u dont get the point ?

ktard pandai baca but tak pandai memahami ka

They sendiri said KPJ amended the report because found out the BP of the patient not normal

Nope. It’s normal to ask such questions as I have worked in claims before and if the clients give good justification, there are no problems approving such claims. Normally, it’s due to non-disclosure as reasons why such claims are queried or the doctor report say something else.

A lot of claims reject stories are not happening to themselves and most are people listening to others tell their stories. A lot of time, people leave out some details when they tell their stories and at the end they will come to conclusion that insurance are scams.

Like I say before, based on my experience, I approved tons of claims every day and most claims got no issues at all but there are always one or two which I will ask for more justification and usually those claims will be rejected at the end by my supervisor. Of course the clients will then appeal and if they can provide proper justifications, it will be approved at the end.

Nevertheless, that was years ago and I work in claims for just a year only.

3 GL required, meaning even hosp knew the forthcoming so need to see all 3 pre and post medical reports and not only 1 as posted in post #1

This post has been edited by jojolicia: Jul 24 2024, 08:21 AM

ada beli PA? jatuh dari tgk 1, I think can claim PA also

how many ppl can fork out 19k in malaysia, 1.9k also very hard

This post has been edited by anakkk: Jul 24 2024, 08:16 AM

park for future reference

That’s why I say disclosure are important. If you don’t disclose when you buy, it will always be a problem when you claim. Insurance companies have doctors as consultants and they know whenever someone did not disclose properly. This problem is usually due to agents who oversell their products and a lot of time they don’t tell the full story about policies. Ask yourself. How many of you really go and read your insurance policy especially the exclusion part?

I agree on the BOLD part.

Whatever it is, the moment got pre-existing conditions, straight up going to decline (Unless can prove otherwise).. hence whats for paying insurance again?
if can't cover 100% for pre-existing, why not co-payment then?

after few incident of insurance not able to cover this and that, we started to go through the policies again.

tbh, one must have a insurance company stock in his investment portfolio.

KPJ is worst when it comes to charges.

meanwhile micare happily pay for company employee je..

should just get micare...

Yours how much they cover? Mine 50k for hospitalisation and 6k for outpatients

my company give.

unli outpatient.
1m for hospitalization..

RM 19 K is not much? What is our currency in Rupiah?

How about looking at it this way?



If a company that big with that much money cannot even pay RM 19 K, then who do you think is the B40 here? So in 2024 we support scammers now? I did not get the memo.

Fuhhhh damn nice then no need insurance for whole family dy. I wonder why micare Google rating so low when my experience with them has always been so smooth

Insurance offer up until gazillion dollar coverage

But never tell you how to claim it

Lol I think he meant why the company didn't want to pay when it's just RM19K which is a small amount to them.

I understand why you and the others would misunderstand his statement though since it's worded badly.

Usually because of discrepancies in doctor's write up of patient's condition and care required

Mind to share why insurer reject?

Seems like bone fracture or something. Did the insured play dangerous sports or something?

i think lots of them tried to scam....

but for actual case... getting gl and processing the payment is so smooth.
sometimes payment take the longest..... but in the end still approved.

used it in prince court, gleneagles, pantai ampang, pantai cheras all no issue

or could be a relapse which previously they did not disclose to the insurance when signing up

Thats why, minor case go to GP is more than enough la. U guys keep abusing medical card just for the smallest of accident.

No need to admit to hospital for small case!

Wow 1mil is very high. U C level?

everyone here the same..

gwai lo company

So before we reach the 500k emergency fund, we just need to ensure we won't incur any hefty medical fees kan?

Imagine if 1 minor case is 19k . Multiply that by 1000 cases in a month. U get my point. Alot of these “people” love to abuse medical card just for the smallest of issue. Thats why for them, there is always alot of reject cases.

They think that just because they paid 100 a month for medical card, they deserve to fully maximize its usage every month for every single accident

so many to abuse the medical card, doctor also same perangai..
better force its to co-insurance laa..

Ayam no Dr but 19K "can be outpatient" sounds strange.

Not possible to charge 19K without surgery. I wonder what procedure was done

Cool

go gahmen hospital je

What they mean is he didnt have to masuk hospital and simply spend 19k when it was just a small case. Just go to clinic can settle RM200

The insurer claimed that it was an issue on the hospital side whereby the hospital’s reporting was inconsistent.

this you should blacklist the hospital and remove them from panel hospital list. you don't punish your customer for the exorbitant charges the hospital claim. customer didn't earn money from that 19k or customer that request for the 19k bill

My friend works as Insurance Agent

She told and shows me the statistics of last year(2023) is the highest amount of people that claim and used the medical card.

Those that use Takaful version of insurance, the money pool is greatly affected.

There are many insurance users like to abuse the medical card, hospitals also same like to mark up the cost of hospitalisation, surgery etc.

That's why nowadays in year 2024, insurance companies started to get a little bit stricter on people that want to use the medical card.

May be insurance just found out got precondition. Could be cheaper than 19k if entered hospital without medical card.
Can claim back all/partial premium paid if terminate policy because of this rejection?

This post has been edited by MGM: Jul 24 2024, 09:26 AM

Last time AIA was really good, but now so big become arrogant...

U still dont get my point. The customer didnt even need to admit to hospital in the first place. Minor case just go to clinic. The issue now is their type of people love to abuse medical card. Even simple cough and cold cases they are going hospital just so they can admit and get MC for few days.

Their whole purpose of their life is not to work but to just sail thru life peacefully. Thats why they love taking MC

Not possible. Simple warding even 10 days wont costs 19K.
The most expensive thing (excluded surgery) is MRI imaging but if bone fracture should just need x-ray that is not expensive.

Very normal. This is where agent comes in play. A good agent will help u to deal between hospital and insurer.
Bad one will MIA.

cb these days case tak viral tak jalan

everybody just sit and wait gaji masuk, padahal slow production la negara ni

AIA keep silent ?

Insurance is a two way thing....

You have policy holders that sikit sikit sakit...claim 1k, 2k...and dare I say...certain medical practitioner writes report so that insurance can be claimed....

You have policies that don't cover complete...and certain conditions....hence, just too bad...such coverage are just absurd

Obviously, it's a business model...and they need to "protect" themselves....otherwise it becomes a charity organization.....and no $$ is made.

For the facebook person....

a) check your policy coverage

b) check if company or personal insurance....

c) check what was the hospital diagnose ....sounds like personal accident, and might not be a health insurance consideration....You might be "huh"...but 2 different policies....

d) Insurance "poncy" regarding...increase premium due to inflation, medical cost, blah blah....and since you are regularly "sick"... need to pay more in co-existing , while moving to "newer/better" policies with "better" coverage...same premium....
are all calculated risks...there is NOTHING "better",except the fact....they wish to readjust the price.
It's called moving the "risk pool" of certain age groups....


It is crazy in other countries....and getting more "bad" in SEA region.

while public hospitals are reasonable/affordable... the "time/patience/system" is still fairly lacking ....
It's a sad price when you get into accident or sick...., and that is why....you need to stay healthy.

should be no operation and spend 19k is not reasonable.

Lel i doubt u are Dr, but neither am i.
However i dont think if insurer say can do outpatient RM200 and hospital will dare dare charge until 19K
Something is very wrong in this case.

Obviously hospital surcharging when they know you're medical card holder.

This is another case that government need to step in and require transparent charging standard for private hospital.

why canteen eat rice need price display but hospital no need?

Read the full thread on X. The agent stepped in to help but can’t do much. When it was viraled out, only then someone from AIA called her to apologize and promised to deal with the hospital side to get it resolved.

At the end of the posting threads, AIA responded with fully covered with the private hospital.

fell from 1st floor leh not from 1 step. like that u still go clinic? for me i will go hospital also at least got x-ray to check if any bone fracture and orthopedic to check thoroughly rather than go clinic first then ask dr to write another letter then go hospital to check again.

Victim said it is their first time claim in 5 years since with AIA. I dont think they abuse, more like hospital found chances to game the insurance.
It's not up to patient to decide the charges and the treatment. More like hospital VS insurance company, then patient become victim.

Dr see medical card straight eye glow jor, 5k job can charge 19k.

There is one major point you guys missed out.

"Inconsistency reports"



Masalah hospital ni, that's why insurance company reject claim