My medical insurance journey, uncovered radiotherapy

 

My medical insurance was purchased in September 2002.

Having paid a total of RM16,800 by the time I discovered I had cancer of the prostate in 2014, I was shocked to discover that, under this policy, outpatient treatment was limited to only RM10,000 for a whole lifespan!

Unless hospitalised for cancer treatment, radiotherapy was considered a form of outpatient treatment. The treatment took less than an hour, after that, the patient would be allowed to go back home.

If I had opted for hospitalisation, in order for me to claim insurance, it would have been a total of 20 nights staying in the hospital.

Initial answers

Both my insurance agent and the customer service manager confirmed that under this medical insurance, radiotherapy was not covered. Since doctors could not justify the need for hospitalisation, it was a Catch-22 situation.

The insurance company made it so seemingly hopeless at a time when a decision had to be made since there was a price involved. It added stress to my life.

If I proceeded with the radiotherapy and hormonal treatment at the private hospital, I would still have to fork out another RM23,000 after utilising the RM10,000 cap.

In my despair, I wrote an email to former Bank Negara Malaysia (BNM) governor Zeti Akhtar Aziz with the hope that she could look into my complaints.

A couple of weeks passed but there was still no response from her. I decided to make it an open letter to the press. Malaysiakini and another English daily published the letter.

Although the article did not carry the name of the insurance company (obviously removed by the press), I received a phone call from the senior management of the insurer, asking to meet me in person.

By then, I was already registered as a patient with the National Cancer Institute for treatment.

There was no reason for me to attend the meeting, but since the senior manager promised over the phone that she had good news for me, I decided to attend the meeting just to see what she had to say.

Good news that came late

At the meeting, there were at least six to eight senior people around the table when I was given the assurance that the policy would, in fact, cover the entire amount of the radiotherapy treatment.

And I was told that I did not need to be hospitalised! Thanking them, I gave them a lecture, expressing my disappointment with the insurance company.

I remember asking them, “Why then did your agent and service manager say I had to be hospitalised before I could claim the medical insurance?”

To my surprise, they told me there was no such rule!

“Did you know that because this so-called ‘rumour’ is widespread, the hospital beds are taken by people who did not need hospitalisation, while those who needed it, could not be admitted?” I asked the senior management that afternoon.

“Your company or through the Life Insurance Association of Malaysia (Liam) should, therefore, issue a notice to all the hospitals to explain that patients need not be hospitalised to allow them to claim medical insurance.”

Of course, after the meeting, I followed up with an email to the central bank to thank them for assisting in my case, and at the same time, urging the bank to make sure that such a ‘rule’ no longer exists.

Since that incident, I have always brought my disputes to Bank Negara Telelink for my cases to be heard.

In the next instalments of this insurance series, I will share how Bank Negara has been extremely helpful in complaints raised by ordinary Malaysians like me.

With this, I hope all of us will cooperate and report our cases to Bank Negara Telelink in order for the central bank to further regulate the insurance industry.

They need real data to understand the extent of a particular complaint in order to enforce certain regulations to protect the policy purchasers and the insured.

More information about Bank Negara’s telelink can be obtained here. They can also be contacted via phone: 1-300-88-5465 (when overseas: +603-2174-1717).

For direct enquiries, the public may also contact Telelink through their newly introduced Live Chat function during their operating hours, Monday-Friday, 9am-5pm. - Mkini

STEPHEN NG is an ordinary citizen who believes that everyone, included the insured, has rights that must be protected.

The views expressed here are those of the author/contributor and do not necessarily represent the views of MMKtT.