Tuesday, October 31, 2017

Peace of mind becomes a nightmare

If you need medical attention, you want the best that you can afford, right?

You want to go to a private hospital so that you do not have to wait in the queue. You can also choose the doctor to treat you. The doctor must be a person who is competent and who you can trust.

It can be a matter of life and death, and you want to get the best for yourself or your family.

The trouble is that it can be quite expensive to be treated in a private hospital. The bill can be three times of a similar treatment in a public hospital. For more complicated cases, it can be much more than three times.

What is the solution to afford the expensive treatment. Of course, buy an integrated plan to cover treatment in a private hospital. Also, buy a rider so that you do not have to pay anything. The insurance company take care of all the medical bills.

The integrated plan is wonderful, isn't it? Sure, the premium is expensive, but it is better to have "peace of mind", right?

The peace of mind can be a nightmare. Let me share the story of Mrs X.

Mrs X was an elderly lady. She was not educated and does not know about insurance and integrated plan. She was covered under basic Medishield for years.

An insurance agent advised her to upgrade to an integrated plan that provides coverage in a private hospital. The agent told her that she does not have to pay any money for the upgrading. That is only partly true, because the higher premium comes out of the Medisave savings.

A year later, Mrs. X found that she had colon cancer. She went to a public hospital for treatment. She was advised to go to a private hospital as it was covered under the integrated plan. Her family checked with the insurance company and was told that the integrated plan would cover the cost of the treatment fully.

Mrs. X incurred a bill of $300,000 for the treatment. It turned out to be quite a complicated case. Her daughter submitted the bill to the insurance company on her behalf.

The daughter was shocked to learn that the insurance company rejected the claim on the grounds that Mrs. X did not disclose that she had diabetes when she upgraded to the integrated plan. Mrs. X said that she had relied on the insurance agent to handle the upgrading. Being not well educated, she was not familiar with the requirements of the insurance company.

I advised the daughter on how to write the appeal to the insurance company. I lost touch with her as she did not come back to me. I hope that her appeal was successful.

I have come across other cases of rejected claims due to alleged non-disclosure when the consumers upgraded to an integrated plan. The consumers had relied on the insurance agent to handle the upgrading.

Many people think that an integrated plan is a god send to meet the high cost of private medical treatment. They may not realize that it could turn out to be a financial disaster, when their expensive medical bill is rejected by the insurance company and they have to foot it on their own.

Tan Kin Lian

1 comment:

Anonymous said...

The agent should be sued and the insurer should pay as it is the principal of the agent and is liable for anything the agent committed. Why isn't it so?
MAS should intervene .

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