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AIA Medical Insurance

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  1. #1

    AIA Medical Insurance

    I worked a full-time job which provided me a decent health insurance, in addition to it I had purchased a Supplementary Major Medical benefit coverage, I thought I was covered for medical insurance via AIA.

    A few months ago, my wife had to have a minor spinal procedure (epidural injections). The attending surgeon’s took pre-approval from AIA for the whole procedure and full cost was supposedly approved. We were not expecting to pay out of pocket for any additional charges.

    The procedure was booked at Adventist hospital under In-Patient. The Operating room fee incurred was HK$12,623, whereas as AIA termed the procedure as “minor” they only covered HK$8,505 under minor operating room benefit. AIA is claiming a Shortfall on the OT charges.

    Under Hospitalization Benefits my wife was entitled to a private room, yet we chose Standard ward to keep the related costs down. Significant savings resulted in various charges including surgeon & anesthetist's fee due to room type:

    Daily room and board: allowed $4000, used $932
    Ancillary charges: Allowed $60,000, used $8,879
    Minor Surgeon’s fee: Allowed $28,350, used $7,584
    Minor Anesthetist’s fee: Allowed $8505, used $1,896
    Minor Operating Room: Allowed $8505, used 12,623

    Total savings $77,446 after adjusting extra $4,118 for Operating Room

    I questioned AIA that savings due to use of cheaper type of room should easily offset the extra cost for the Operating Room.

    AIA responded on Oct 10 that there was no arrangement to use the savings to cover the shortfall incurred.

    Any thoughts out there?


  2. #2

    Join Date
    Aug 2006
    Location
    Hong Kong
    Posts
    658

    Given a choice, I would go with AXA or other insurance companies than AIA or BOC, after living in HK for ages.


  3. #3

    Join Date
    Apr 2003
    Location
    Hong Kong
    Posts
    3,988

    not using the maximum allowance cannot be considered to be a cost saving.

    D.YU likes this.

  4. #4

    ..


  5. #5
    Quote Originally Posted by JAherbert:
    not using the maximum allowance cannot be considered to be a cost saving.
    Even if the allowed amount is per day, or per sickness and may have applied if I had used Private room instead of Ward?

  6. #6

    Join Date
    Jul 2005
    Location
    Pearl of the Orient
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    4,006
    Quote Originally Posted by JAherbert:
    not using the maximum allowance cannot be considered to be a cost saving.
    True. I have just asked my wife, who with shame I have to admit was a lawyer with AIA many moons ago.

    Also I remember posting some time ago the insurance company allowance for the OR is no where even close to reality, and trying to get estimates on costs, either from the surgeon or the hospital admin, verging on the impossible.

  7. #7

    Join Date
    Nov 2017
    Posts
    520

    Insurance is paid per item and not paid as a whole.
    Sorry but you have no way to recoup any fees.
    You can try to repeatedly chase and see if they will relent but unlikely.


  8. #8
    Quote Originally Posted by Cwbguy:
    insurance company allowance for the OR is no where even close to reality, ...
    I wonder if it is on purpose, the insurer knows OR cost will always be higher and thus they could always demand shortfall even if they offer an overall cover for $1 million? If true, it is technically fraud.

  9. #9
    The total cost for the procedure was about $32K and shortfall is $4000. The average relatively healthy family could pay out of pocket for their medical care and spend less than they do on medical insurance.

  10. #10

    Join Date
    Dec 2002
    Location
    薄扶林
    Posts
    47,965
    Quote Originally Posted by Taikoowan:
    The total cost for the procedure was about $32K and shortfall is $4000. The average relatively healthy family could pay out of pocket for their medical care and spend less than they do on medical insurance.
    Get your self set up at the highest possible deductible.. This will partially self insure you and cover major medical.

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