Do you need cashless admission medical insurance?

Do you need cashless admission medical insurance?

Have you ever had to rush to an ATM in the middle of the night because someone needed medical attention? Have you asked for money from friends or family?
You even used up all the credit card limitations, yet the private hospital does not allow your family to the admission. What shall you do?

Cashless hospitalization aims to avoid such situations. The insurer pays the hospital directly, based on the annual limit.

Do you need cashless admission medical insurance?

a cashless hospitalization

Do you need cashless admission medical insurance?
Do you need cashless admission medical insurance?

Companies partner with hospitals after analyzing their medical services. These facilities are part of the cashless network, so you don’t have to pay to use them. The insurance company uses third-party administrators (TPA) to deliver to the hospital directly.

Cashless hospitalization did in two ways:

Inpatient stay

If you can’t plan and determine the network hospitals, check your policy document or call the toll-free number. Here are the steps to take.

• Get a pre-authorization form from the hospital insurance desk or download it from the TPA website. Both the patient and the doctor must sign the form.

• Submit the completed form submitted to the insurance desk for verification.

• The TPA then approves the form.

• An authorization is then sent with the sanctioned amount.

Emergency hospitalisation

If you an admission urgently, follow these steps:

• Show your HEALTH INSURANCE card with your policy number and coverage details.

• Fill out the authorization form available at the insurance desk.

• If you can’t wait for TPA approval, you can pay the hospital bill and later claim reimbursement.

Do you need cashless admission medical insurance?

Now let’s look at cashless hospitalization.

• Keep in mind that this service is only available to the panel hospitals. To find cashless hospitals in your city, visit the insurer’s website.

• Planned claims require advance notification. It includes pre-and post-hospitalization expenses.

Do you need cashless admission medical insurance?
Do you need cashless admission medical insurance?

• Notify the insurance company of emergency hospitalization within the maximum time frame. The policy document will contain this information.

A cashless hospitalization

• If hospitalized, you don’t have to worry about finances, which is a relief.

• Knowing you are adequately covered ensures you receive the best medical care.

To avoid unpleasant surprises, read the terms and conditions and understand the inclusions and exclusions of cashless hospitalization insurance. Keep copies of all bills, reports, claim forms, and discharge papers if you need them later.

Do you need cashless admission medical insurance?

The Value of Cashless Health Insurance

People are often cash strapped due to rising medical costs and crises like the current pandemic and cannot always afford medical expenses. As a result, cashless health insurance is a big help because you can get treatment without immediate cash access. You must go to one of your health insurance provider’s network hospitals to receive treatment.

It will give you peace of mind and reduce unnecessary stress. It save you time and energy when settling your claim with the insurance company.

Do you need cashless admission medical insurance?

Cashless vs Reimbursement Claims

The policyholder either pays a monthly or yearly premium to cover the family members’ medical expenses covered by the policy. The reimbursement process can be cashless or through reimbursement claims. So, here’s the difference:

Cashless

The cashless feature of the health insurance policy means the policyholder does not have to pay upfront for hospital treatment. In such cases, the insurance company and the hospital settle the bills without the policyholder having to pay cash.

Payment claims

The policyholder must first pay the hospital in cash for reimbursement claims and then apply for reimbursement with the insurance company. So, the policyholder pays the hospital first, then the insurer. The reimbursement option is used for treatments not received in a network hospital.

Do you need cashless admission medical insurance?
Do you need cashless admission medical insurance?
Do you need cashless admission medical insurance?

Two scenarios with medical insurance
In the olden day, there wasn’t any cashless admission medical insurance. One of my relatives suffered so much to save his father’s life. He sold 16 acres of matured oil palm land at a discount rate.
A wealthy heartless buyer slashes his selling price twice a week, aware of his predicament. With one hundred thousand dollars, they flew off to Chennai for his father’s kidney transplant. Luckily, it was a successful operation, and he lived until he was 78.

Probe this hardship they have undergone. Was it not painful to dispose of the land at a discount price?

A dog lover woman bred a German shepherd at her big bungalow compound in another case.
After her husband’s dismissal, she grieved so much that later she too suffered a pancreas cancer in April.

Even though she had brought her cashless medical insurance for only forty thousand for one admission, it was insufficient for a single operation.

Pancreas cancer is a long-term illness, the forty thousand soon exhausted, with only Hudson’s choice left for her business owner’s son.
To save her mother’s life, he re-mortgaged his residence to the bank for one hundred thousand dollars.

Do you need cashless admission medical insurance?
Do you need cashless admission medical insurance?

When one person is dying, the family members listen to those so-called quack doctors for all kinds of expensive Chinese herbs to boost her immune system, besides the usual chemotherapy.

In July month, I paid her a visit to her home. Hardly I could recognize her. A frame of 65 Kg dramatically dropped to 40 kg in 3 months. With her emaciated body and a pair of hollow eyes on a skeleton body, she could hardly have the energy to swallow that semi-fluid food.

I received terrible news from her son in October of the same year that she passed away in the government hospital as her son had used up altogether two hundred thousand dollars since April.

Two hundred forty thousand could not save her life. Do you realize how skyrocketing medical costs are nowadays?

Do you need cashless admission medical insurance?

Now is the time to have a cashless admission medical policy. Review your existing policy, and it suffices to cover the primary operation. If it is inadequate, please buy a supplement policy to have a lesser exclusion endorsement in your policy.
Do not listen to those unscrupulous insurance agents to surrender the policy. Your health is not the same as five years, assuming you purchased a policy then.

Also, a soft reminder, check your policy for the annual limit and whole life limitation of the sum insured. Is it coverage up to 80 or, even better, 100 years old? As with improving medical health care, our life span lasts longer than our fore-parents.

Your Views
As always, please leave any ideas or questions in the comments area below.

Utmost Good Faith Binding Between Insured And Insurer Part IV

Utmost Good Faith Binding Between Insured And Insurer Part IV. The insurer has a bigger role in Utmost Good Faith binding both parties namely the insurer and the insured.

Liver Transplant Tragedy

Friday, June 7, 2002, on Singapore Strait Time carried the title ” Transplant tragedy:  Heartbreak for wife  ‘He died not knowing I was pregnant’ Transplant tragedy: Too much money, Too little time Frantic rush to raise funds. Liver Transplant tragedy”  Donor available, but critical delay over cost proves fatal ”  No Money, No surgery.

A sorrowful heartbreak story flashing across the local daily newspaper. People cursed the heartless surgeon. The Insurer refused to pay the so-called cash admission in the local private hospital. He later was transferring to another private hospital in Singapore for a liver transplant. The donor was none other than the late patient’s elder sister who sacrificed her own liver and spending the countless sleepless night to raise the fund for her beloved younger brother.

Jaundice

The local hospital diagnosed him suffering from jaundice. He needed to pay admission fee RM5,230.00.  The medical card was supposing to be a cashless admission. Finally, the consultant confirmed he suffering from Hepatitis B.  Like adding salt to the wound, time delay, patient in critical condition, the ambulance rushed him off to a Singapore private hospital to perform the liver transplant.

No money, no surgery

“First you need to find the right donor for a liver transplant, secondly, S$300,000 full payment as cash deposit before the surgeon can perform the operation.” the hospital concerned informed them, “No money, no surgery

To cut the story short, the money was raised, the elder sister admitted to hospital for the liver transplant on the following day.  Her youngest brother could not hold longer, was called to be with The Lord in the wee hours of the morning.

Whatever is gone, ash to ash dust to dust, but the living need to go on with their life. The deceased family filed a claim for sum insured of RM75,000.00 to the general insurance company for the medical card claim. The shocking reply from a party of the insurer.

Not Claimable

It is with deep regret to inform you that the medical expenses for the treatment of your condition are not claimable under the following policy exclusion:

General Exclusion (11) – ” suicide or attempted suicide, self-inflicted injuries, self-destruction or any attempt thereat while sane or insane. ”

General Exclusion (9) – “… treatment of alcohol dependence syndrome and drug addiction/abuse.”

After countless visiting the hired lawyer, no outcome. But the lawyer charged the family for RM2,000 to open a file. Also, written a numerous of appeal letters to Malaysia Mediation Bureau turn out to be fruitless.

It was a coincidence I stumbled across his sister, after a few chat, only did we realized we were colleagues before. We chatted over a high tea.

” Jamin wong, can you help me to claim my late brother case. Since after we departed, you continue with Chartered insurance study, I am sure and you have the confidence to help me.” she pleaded me.

” Sure, It is my pleasure to help those genuine claim, but those lawyer’s correspondence letter please do not give to me, I want the proposal form, cover note, policy jacket, and rejection claim letter. If I had 90% winning the case, I will write an appeal letter on your behalf to Bank Negar Insurance Mediation Bureau, is that ok with you.

In the proposal form, the brother did write that he was a hepatitis B carrier.  Also,  there were no exclusion clauses specify in a few years renewal. After close study of the liver specialist’s diagnostic report confirming the patient died of an acute liver failure due to Hepatitis B.

Insurer did  not honor Utmost Good Faith

The insured had carried the duty of Utmost Good faith in disclosing he was a hepatitis B carrier in the proposal form. Whereas the insurer did not honor the Utmost Good faith on their part.

Happy Ending

With just one A4 paper size written in the appeal letter.  All happy ending . On the 30-7-2004, the widow received a cheque amounting to RM75,000 from the insurer.

Two policies cover the same consignment, small claim response, but bigger sun insured claim was rejected.  Another story not follows the Utmost good Faith rule by the insurer, more in the next episode.

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Utmost Good Faith Binding Between Insured And Insurer Part IV 1Utmost Good Faith Binding Between Insured And Insurer Part IV 2
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Utmost Good Faith Binding Between Insured And Insurer Part IV 3