Like Tree8Likes
  • 1 Post By aming
  • 1 Post By Raccon
  • 1 Post By 100LL
  • 1 Post By justjoe86
  • 1 Post By aming
  • 1 Post By Football16
  • 1 Post By hullexile

Denied a Medical Claim - What can we do?

Closed Thread
  1. #1

    Join Date
    Dec 2009
    Posts
    11

    Denied a Medical Claim - What can we do?

    My fiancee was recently denied a medical claim by insurer ManuLife stating that her stomach pain was "pre-existing" to the policy coverage and that the doctor visit was within the 30 days grace period after the policy was in effect (we saw a doctor on the 28th day of the grace period for the initial exam).

    The initial doctor visit was followed by an endoscopy exam about 3-4 weeks later and at the recommendation of the initial doctor. This exam cost HKD $8000 and Manulife refuses to pay for the examination claiming that the initial visit occurred within 30 days and that her condition was pre-existing. What is even more frustrating is that she had called the customer service center line many times in advance and received verbal confirmation that the Claim would be paid.

    Is there a legal aid society or any organization in Hong Kong that would be able to help us fight for this. While it is not a lot of money, it is clearly the principle that we are fighting for. We have now heard that Manulife has a terrible reputation for finding many ways to avoid paying claims on exams by Patients.

    dear giant likes this.

  2. #2

    Join Date
    Oct 2008
    Posts
    1,369

    You have my sympathies. Many insurance companies seem to be a scam insofar as they charge for a service that they will go to insane lengths to avoid providing, with fine print and policies carefully designed so as to make it insanely difficult to derive any benefit from their services.

    How can anyone derive any peace of mind from having insurance when the insurance companies behave as they do? *sigh*


  3. #3

    Join Date
    Sep 2008
    Posts
    3,677
    Small Claims Tribunal

    Do send a registered letter to the insurance about the issue and keep records with dates about any communication in written or spoken form.

    Oh, and in future do not trust any confirmations, else make sure you have the name of the person at the other end of the line and/or a recording as proof (assuming such is legal and admissible in court).
    Last edited by Raccon; 16-03-2012 at 07:46 PM.
    dear giant likes this.

  4. #4

    Join Date
    Apr 2008
    Posts
    2,879

    Well, the first step should be to cancel your insurance policy with them.

    dear giant likes this.

  5. #5

    Join Date
    Dec 2009
    Posts
    11

    Thanks

    Original Post Deleted
    Thanks so much for the tip. I'll lodge a complaint there. I hope some resolve can come of it. Its unfortunate that I have to resort to this.
    dear giant likes this.

  6. #6

    Join Date
    Dec 2009
    Posts
    7,471

    'Pre-existing conditions' are a load of bollocks IMO. If I break my arm will they tell me I can't claim because it's a pre-existing arm, and that arm was always breakable? It was due to pre-existing fate? It was broken by a pre-existing cricket bat?

    They should ask the relevant questions, and do the relevant research, BEFORE they offer you a policy. But that would be too much like hard work so they hire people to scan the small print for get out clauses. Of course they also hire people to WRITE these get out clauses. Probably the same bloody people.

    "Well, we offered you this policy, but in hindsight we think we shouldn't have, because you got ill, and we only want people who don't get ill... so you can't have it anymore... oh and your future rate has just gone up."

    Funny how they can be so slapdash when offering the policy and then so attentive to detail when you actually come around to claiming.

    If they got their way they'd have a clause which says "in the event that shit happens, shit happens."

    Bloody insurance companies.

    End of rant.

    Last edited by justjoe86; 17-03-2012 at 05:01 PM.
    dear giant likes this.

  7. #7

    Join Date
    Mar 2006
    Posts
    4,043
    Quote Originally Posted by aming:
    My fiancee was recently denied a medical claim by insurer ManuLife stating that her stomach pain was "pre-existing" to the policy coverage and that the doctor visit was within the 30 days grace period after the policy was in effect (we saw a doctor on the 28th day of the grace period for the initial exam).

    The initial doctor visit was followed by an endoscopy exam about 3-4 weeks later and at the recommendation of the initial doctor. This exam cost HKD $8000 and Manulife refuses to pay for the examination claiming that the initial visit occurred within 30 days and that her condition was pre-existing. What is even more frustrating is that she had called the customer service center line many times in advance and received verbal confirmation that the Claim would be paid.

    Is there a legal aid society or any organization in Hong Kong that would be able to help us fight for this. While it is not a lot of money, it is clearly the principle that we are fighting for. We have now heard that Manulife has a terrible reputation for finding many ways to avoid paying claims on exams by Patients.
    Pre-existing conditions are something anyone with private health coverage has to be concerned about.

    Not sure what you mean by a grace period which usually is about payment. You might though mean waiting period which means maybe that a person went to the doctor on the 28th and the policy was not to take affect until after 30 days.

    This by Googling is a Manulife description of the term and there is a whole other section on exclusions. It might not be your policy so you need to check that.

    "
    9. What is a “Pre-existing Condition”?
    Sicknesses or injuries that occurred prior to the member joining the policy are called “Pre-existing Conditions”. Benefits payable for treatment relating to pre-existing conditions are generally not covered under the policy during the first twelve months from the date the member joins the plan. The exception to this is where there was no treatment received or recommended during the first three months from the date the member joins the plan in which case the pre-existing condition clause does not apply."
    The problem is even if you can get them to admit an error in advice that it will be a challenge when it comes to the pre-existing condition.

    You can certainly press the point and complain as as long it doesn't become worse for you than sucking it up and eating the cost but it can be a tough thing to dispute as we know that ignorance of these clauses does not make the case.

    You could also go to the company's benefit administrator (in Canada you could - not sure about this part of the world) and ask for some advice or the insurance complaints process.

    But very few insurers will make exceptions to an insurance policy being in effect if that is the case here. If the policy did come into effect until 30 days later that is a key negative in your case for getting that visit covered.

    Now getting the downstream costs covered is something that you can push them on.

    These are very good reasons for people to understand their insurance policies.
    Last edited by Football16; 17-03-2012 at 05:19 PM.
    dear giant likes this.

  8. #8

    Join Date
    May 2006
    Location
    Pampanga, Philippines
    Posts
    29,875

    Well all I can say is that BUPA have been bloody brilliant with me, accepting claims I thought they would refuse (they could have easily got out of some of them) and paying out each time in days. They also have an excellent FREE "second opinion service" where you speak to a doctor, by phone (their cost) and email then get two second opinions from experts in the field. Can't praise them highly enough really. I particularly liked the second opinion that said (with some ifs) that I should live a full and long life. Compared to my doctor who has the bedside manner of PDLM on a bad day who on leaving his surgery recently was told "see you next month......if you are still with us".

    dear giant likes this.