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?