Good Policy - Stupid Implementation

Insurance policies are supposed to be a promise in black and white that ordinary men in the street purchase with the hope that, when disaster hits, there is sufficient fund to carry through one’s life.

If it fails to deliver, the policy is nothing but a worthless piece of paper. Few people would scrutinise the fine prints when deciding to purchase a policy. This is where many of us find ourselves in a dilemma when disaster really hits.

In November last year, I discovered that I have prostate cancer after doing a full health screening. On further diagnosis, the urological surgeon confirmed that it was an aggressive form of cancer. He suggested that I should avoid surgery at all cost, because radiotherapy and hormonal treatment is less invasive and will give an equally good outcome.

He could have performed the surgery himself and the medical insurance would have to pay for it. Instead, he suggested radiotherapy, which is concurred with the oncologist’s recommendation.
The decision was also medically sound, but after consulting my insurance company about the medical treatment, I was told that, while an operation can be covered up to RM400,000, the treatment package suggested by the oncologist is considered ‘Outpatient Treatment’.

Because of the advancement in medical technology, both hormonal treatment and radiotherapy does not require hospitalisation; therefore, the insurance company would not pay more than RM10,000 for a whole lifetime because the treatment recommended by the doctors is considered ‘outpatient treatment’.

I am not the only person who has been paying an annual premium of RM1,400 for my medical insurance the past 12 years, only to discover that it has a cap of RM10,000 (a whole lifetime) for outpatient treatment.

While waiting for my consultation, I overheard one other gentleman having the same problem that I was encountering. This is devastating, especially having trusted in the company enough to purchase life, medical and household insurance for myself.

I think it is unfair that the insurance company should determine the payment based on whether it requires hospitalisation or just outpatient treatment. They should allow the medical specialists to decide what’s best for the patient.

Because of the way how the policies are written, some doctors try to help their patients by creating reasons to hospitalise them. This is done at the expense of other patients who need the hospital bed.
There is no reason to blame the doctors and saying that they are unethical; it is the way the insurance companies have crafted their policies that make it a necessity for doctors to keep their patients in the ward. Why should the patient’s well-being be ‘governed’ by ridiculous clauses in the insurance policy?

Tell me, what treatment cost less than RM10,000 especially when it has to do with the Big C (Cancer)?  By setting a cap to ‘Outpatient Treatment’ using the fine prints, especially for anything to do with cancer treatment, is simply cruel.

In fact, I could have opted for surgery which would cost a lot more than radiotherapy and hormonal jabs. Why should insurance companies be so blind as not to see their folly?

Most lay people would not fully understand the implications of the fine prints until disaster hits. This is where the authorities such as Bank Negara, which governs the insurance industry, should seriously look into the lack of transparency in insurance policies sold in Malaysia.