Medical Claim Barriers

SOME months ago, I was hospitalised for nausea, high fever, constant vomiting and muscle weakness. Initial tests ruled out cancer, but subsequent tests confirmed resistant bacterial infection, which needed strong antibiotic drips.

Decisions for additional tests and treatments were based on the insurance policy, which had numerous exclusion clauses and conditions that needed to be met before such tests could be claimable.

The policy stated that hospitalisation had to be for 24 hours for any fees could be claimable. This requirement was fulfilled since the doctor insisted that I had to be admitted for eight days.
I had learnt my lesson years ago when I was hospitalised after an accident but voluntarily checked out within 24 hours, which rendered my claim void.

There are certain tests and treatments that are only claimable upon performing other medical procedures, without which, the whole amount would be non-claimable.

This is ridiculous. Certain procedures are dangerous if not needed, leaving the insured in a dilemma.
It is unfair how insurance policies dictate how we fall ill or die before any sum is claimable.
Insurance companies have such unreasonable clauses that it is no wonder that the eventual hospital bill charged to the insurance company is exorbitantly high since there are so many unnecessary procedures that need to be done to ensure that the charges are claimable.

With the advancement of medical technology, some serious illness, even cancer, can be treated with simpler medical procedures.

Complaining to the Financial Mediation Bureau is a long affair, which decides cases based on terms and conditions in the contract but gives no leeway to debate the unfair contract terms and unreasonable mutuality clauses, where one claim is claimable only if another medical procedure is performed.

The National Association of Malaysian Life Insurance Field Force and Advisers, and Life Insurance Association of Malaysia must work to review unfair contract terms in insurance policies.
One way is to introduce an Unfair Contract Insurance Terms Act to ensure that the terms and conditions of insurance policies are simple and straightforward.

Such an act must be applied retrospectively so that existing insurance policy holders have an avenue to challenge any unfair terms and conditions of the policy.

Policy holders often have their claims rejected over a minor detail and/or the non-performance of an unnecessary medical procedure.

Falling sick or being involved in an accident that requires admission to a hospital is stressful.
In desperation, most insurance policy holders would take the easier way out, and submit to unnecessary tests and treatments to ensure compliance with the policy, leading to a vicious circle of escalating healthcare cost and insurance premiums.

Ng Shu Tsung, Kuala Lumpur