Claiming from a Hospitalization Plan

[dragon]

Hi to all forumers in insurance-related professions or had such professions previously, or who had similar experiences like my friend's:
I would like to seek your advice pls. My friend was recently diagnosed with a medical condition that required surgery to treat. She had an As-Charged hospitalization insurance plan, and so provided her insurance agent with all the details such as diagnosis, operation name, estimated cost, etc and asked him to confirm whether she will be covered under the plan. Her agent told her that it "should be", and that the amount that can be claimed will be calculated after the surgery was completed. My friend wasn't sure whether to proceed with the surgery as it's very expensive and the agent only gave a non-committal answer. May I pls know:
- can my friend ask the agent for black-and-white confirmation of whether the surgery will be covered by her insurance plan?
- can she ask the agent for black-and-white confirmation of which parts of the surgery costs will be covered eg. ward stay, operation costs, medicine, etc?

Thanks in advance!

[Darren Lee]

Hi Dragon,

Most agent will not be able to give you a committed answer becos there are times that some misc. items that pops up that is not covered under the policy.
Generally speaking however, in most cases your friend will need to note a few things:

0) Is the medical condition deem to have started before or after her policy start date? Is it medically necessary?
1) As-Charge hospitalisation are meant to cover for In-Patient i.e being warded. The impression I got from your descricption sounded like a Day-surgery case i.e no need to be warded.
2) Does her current plans have any Pro-Ration factor? Meaning is there any restriction if she goes to Private hospital since the surgery is expensive i'll assume its surgery in private hosp.
3) Any riders to her current plans?
4) Does her insurer provides Letter Of Gurantee (LOG)? Most Private hosp will require a deposit say $10K or so (cant rmb the figure), most insurers nowadays do provide LOG so that the insured need not fork out the deposit. If unsure call the agent, if the agent also not sure, call insurer directly.
5) Most Hosp. Plans (as-chrg ones) will cover for Day surgery, you need to check the policy document or call insurer direct to check the Day-surgery claim limits.

To speed things up, you can always call the insurer direct, becos most agents will do the same thing client ask abt claim matters, they will have to check with their claims office.
Hope this helps to point you in the right direction.

Hi to all forumers in insurance-related professions or had such professions previously, or who had similar experiences like my friend's:
I would like to seek your advice pls. My friend was recently diagnosed with a medical condition that required surgery to treat. She had an As-Charged hospitalization insurance plan, and so provided her insurance agent with all the details such as diagnosis, operation name, estimated cost, etc and asked him to confirm whether she will be covered under the plan. Her agent told her that it "should be", and that the amount that can be claimed will be calculated after the surgery was completed. My friend wasn't sure whether to proceed with the surgery as it's very expensive and the agent only gave a non-committal answer. May I pls know:
- can my friend ask the agent for black-and-white confirmation of whether the surgery will be covered by her insurance plan?
- can she ask the agent for black-and-white confirmation of which parts of the surgery costs will be covered eg. ward stay, operation costs, medicine, etc?

Thanks in advance!

Cheers!

[dragon]

Thanks for your detailed reply, Darren!

[chuajinyi]

Hi

I was told that the next renewal for Private Plan for Great Eastern SUPREME HEALTH and TOTAL SHIELD doubled for my each of my parents ( est 2000 cash each for age 66 to 70).
I check the website brochure, indeed.

Cross check in Aviva website, MyShield and MySheild Plus, has similar price.

I believe what Dennis has taught, P-Plan so that we can receive immediate and the fastest medical attention when needed.
But the price has escalated by 50%.
What options do I have, please advice?

Thank you

[spezlezz]

Yes, medical cost in that senior citizen age is always high as the chances of them getting hospitalized is higher than younger people.
They also need longer medical treatment.

If affordability is an issue, then consider downgrading to the next level which is affordable to your family.
It is better to have some coverage than to have none at all. We buy insurance to offset a large part of the medical bill.
I think I will also have to downgrade my plan when I reach senior citizen age group

I recall my friend whom bought a private hospitalization plan that covers his mom medical expenses.
Premium is around $5K/year.

If anyone else have a better suggestion, please voice out.

Tks,