I was attending a friend’s party where Fred was sharing with us what his father went through when he undergo a slipped disk surgery. Upon admission, his insurance company declined his cashless admission (GL) and he can only claim his medical bills on reimbursement basis. He never questioned the company as he didn’t mind paying first. A week after his surgery, he was still in severe pain and the doctor advised him to undergo another surgery. However, it did not rectify the problem. The pain was so acute to the point where he actually contemplated suicide. It was only after the third surgery – when the family found out that the doctor assigned was actually blacklisted and all the surgeries he underwent were deliberately performed. This was the reason why the insurance company declined his cashless admission for investigation purpose.
That evening really got me thinking. Most of us are commonly equipped with the benefits of a medical card and the general clauses. How often do we read the policy contract to get a comprehensive understanding? Even so, we might not understand their jargon. In this post, we will share with you some of the Uncommon Facts on Medical Card you may or may not have heard of!
For cashless admission, the insurance company must issue Guarantee Letter (GL) to the hospital. If GL is declined, your hospital bills are still claimable. The company only seeks to perform some investigation and the claims will be paid on reimbursement basis. Few reasons why GL can be declined:
(a) Medical card is less than 1 year= (depends on type of illness/diagnosis) and;
(b) Illness have possibilities of being pre-existing
(c) Non-disclosure of health condition upon insurance application
(d) Doctor assigned is blacklisted – Kindly perform a background check on your doctor prior to admission!
If your admission is scheduled, you can actually request the doctor to submit for GL approval a few days earlier to avoid any delay. If any problem occurs, your agent has more time to help you rectify it. This ensures a smooth procedure during the day of your admission.
In order to claim your post hospitalization bills, take note that the treatments must be from the same primary doctor who admitted you to the hospital. Any change of doctor for your follow up treatments has to be supported by a Referral Letter from your primary doctor. Otherwise, your claim will be void.
Ensure that all receipts and invoices issued are original. The company will not accept duplicate of the original version or your claims will be declined. If you only realize it later on, it’ll be too late as the hospital is unable to provide you the original due to Standard Operating Procedure (SOP).
Plastic surgery and dental treatments are only claimable if they are medically required or due to accident.
You can actually claim your overseas treatment incurred during your travelling. However, you must not be out of the country for more than 60 or 90 days (Depends on your insurance provider).
Under your medical card benefit schedule, Emergency Accidental Outpatient Treatment allows you to claim any injury treatments due to an accident even if you’re treated in a clinic. However, do take note that you have to seek your first treatment within 24 hours from the accident. If not, your claims will be void.
There is a 30-day waiting period for simple illnesses such as dengue, food poisoning, viral infection etc and a 120-day waiting period for specified illness. These specified illness list is stated in your policy contract. On the other hand, there is no waiting period for admissions due to accidents.
Admissions to non-panel hospitals are actually claimable, except that it will only be on reimbursement basis.
Certain insurance providers actually allow you to claim your admission to hospitals in Singapore & Brunei. The claims will be based on their country’s currency exchange and customary charges.
Click here to read more on proper guide to plan your medical insurance planning.
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