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?

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.

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?

There’s no best insurance companies when it comes to claims. You think Manulife and Allianz won’t reject claims? They are all the same and if you see the people in their claims department, it’s usually the same people in the industry. They just move to other insurance companies.

The biggest problem today is the rising insurance costs and insurance companies has been more strict when it comes to claims as it will hit their profits and if uncontrolled it will cause medical insurance cost to rise even more and it will affect everyone and not only insurance companies.

The most important is you must know what you’re signing for and don’t leave everything to the agents. Most important is scrutinise your policy kao kao and ask your agent kao kao. You’re already paying your agents and they should work for you.