Aku dan Statistik

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Kata Carian

12 September 2010

Aku dan Medical Insurances(2)

Horror tales when it comes to making claims

PATRICIA Lam* was diagnosed with a tumour in her neck artery. Her treatment required a section of the artery to be removed and replaced with a prosthetic artery. Part of her medical expenses were covered by her company’s group insurance while the balance was to be covered by her personal medical insurance.

However, she and her company had difficulty claiming on the insurance as they said the prosthetic was for “beautification purposes”.

“That was totally ridiculous. Without the prosthetic, I would have died! It was so difficult to get the money for something clear-cut,” says Lam.

It took over a year before the claims were paid, and only on the threat of taking the insurance company to court.

Two years later, she had to undergo another surgery for cervical cancer. She tried to claim a lump sum payment on her critical illness cover but was initially rejected because the company said it was “pre-cancer”, which was not claimable. It took another six months before the claims came through.

“Their practices are very questionable. They try to find all possible loopholes so they don’t have to pay. Even the agent who sold me the policy was surprised it was denied,” says Lam.

R. Hari*, who holds a medical card, suffered acute pain in his arm and shoulder and was referred to a private hospital by a clinic. After a two-hour wait, his admission was approved and he was subsequently warded. Late in the night, however, he was told to leave the hospital as the insurer did not agree with the recommended treatment. To his embarrassment, he was unceremoniously ushered out of his room even though he was still in pain. He then went to a government hospital where he was admitted.

The next morning, he received a call saying that his treatment had been approved. But the call came from the private hospital and not the insurers, who were well aware he had been “chased out” earlier.

His condition did not improve, and he fainted and had to be warded at the intensive care unit of the government hospital for two days. He spent another six days in the regular ward before he was discharged.

“I was surprised because when I studied the documents, I found that the cancellation of the approval was not signed by a doctor, but by someone else ‘on behalf of’,” he says.

“I intend to take action against all parties involved and seek compensation for the hardship and suffering I had to go through.”



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