Medical Cover Problems

[rcalsop]

I recieved a nasty suprise recently following Cardiac Stent insertion recently in Penang I got an unexpected bill from the Insurance company ING who have taken the view that they will not pay for the actual Stents as they are catergorised under the same category as hopitsl dressings and equippment and that category has a low claim limit ... The bed costs no problems I used nothing like the limit I stayed overnight only and went home , the surgeons fees less than half the limit all other fees okay except , the claim for excess cost on the bits and bobs dressings and fittings side is above 19000 ringits . They pay about 9000ringit I pay 19000 plus

The attitude of both my company and the insurance company is pay up tough shit read the small print ...if I had elected to have open heart bypass very few bits and bobs no stents so it would all be covered, and twice the price ......

The attitude is, this is normal sir but I think not ,my belief is that on checking the normallity is that once the Medical cover says it is covered (which they did ) it is covered and if it exceeds their expectations on cost they will fight with the hospital and not the patient . I would like to hear of similar cases problems or indeed sucess stories so I can confirm my own findings and be able to quote cases showing what a normal insurance company does with this sort of claim It may help me fight them . ONCE AGAIN IT WAS ING INSURANCE >>>TAKE CARE

[canopus1969]

ING is a Life Insurance company - why not go with a real Medical Insurance company if you want health coverage ?

[rcalsop]

Two simple answers for you 1/ .ING group is a multi national group with wide insurance cover over many areas and types of insurance , 2/ The policy was a company policy that was a benefit of employment they choose the the policy to buy ....I have little control over which company to use .If your company in the UK provides a car do you have control of the insurance company or choice for breakdown cover AA or RAC etc ??????

[Sheryl]

With any insurance, it is NOT the case that the insurance company will "if it exceeds their expectations on cost they will fight with the hospital and not the patient ". Virtually all policies have caps for how much they will pay for specific proceudres and if this is less than the hospital charges, uness the hospital agrees in advance to accept the lower payment, then the patient pays the difference. That said, a good hospital will investigate this before hand with the insurance company and find out what will be covered and let the patient know if there is going to be an out of pocket cost -- especially for a costly procedure like this.

In fact, had the hospital simply included the stent cost in the surgical cost instead of listing it separately you would probably have no problem. Your difficulty stems from the hospital not having looked into the insurer's policies and billed in a manner that creates problems. The fact that you have an unusual insurer (i.e. one that the hospital probably does not often deal with) may have added to the difficulty.

That said, it is probably too late to get a revised billing.

Most insurance companies have some sort of appeals process, I suggest you appeal on the grounds that the cost of the stent is an integral part of the surgical fee. It sounds like they are treating the stent under a category meant for consumable supplies, which is not appropriate. (If you can, see what category an artifical pacemaker goes under, that would be a similiar example).

Most insurance companies have a procedure whereby you can get pre-approval or a surgical procedure or hospitalization and they inform you at that time of any costs that will not be covered. Of course, this doesn't apply to emergency situations, but it is worth doing for anything else to avoid unpleasant surprises.

Good luck.

[Totster]

Moved to Insurance forum

totster

[H2oDunc]

Two simple answers for you 1/ .ING group is a multi national group with wide insurance cover over many areas and types of insurance , 2/ The policy was a company policy that was a benefit of employment they choose the the policy to buy ....I have little control over which company to use .If your company in the UK provides a car do you have control of the insurance company or choice for breakdown cover AA or RAC etc ??????

I would put it to you that it is up to you what cover you have. If you think the cover that is provided by your employer is inadequate then I would take out a top up with a company and policy of my choosing. Same as whenever I had a company car. They may have covered the car with one of the lesser known recovery services or none. I always had my own AA cover as it is the person who is covered with the AA not the vehicle. Having adequate insurance when abroad for me is a must!

[tonydabbs]

I recieved a nasty suprise recently following Cardiac Stent insertion recently in Penang I got an unexpected bill from the Insurance company ING who have taken the view that they will not pay for the actual Stents as they are catergorised under the same category as hopitsl dressings and equippment and that category has a low claim limit ... The bed costs no problems I used nothing like the limit I stayed overnight only and went home , the surgeons fees less than half the limit all other fees okay except , the claim for excess cost on the bits and bobs dressings and fittings side is above 19000 ringits . They pay about 9000ringit I pay 19000 plus

The attitude of both my company and the insurance company is pay up tough shit read the small print ...if I had elected to have open heart bypass very few bits and bobs no stents so it would all be covered, and twice the price ......

The attitude is, this is normal sir but I think not ,my belief is that on checking the normallity is that once the Medical cover says it is covered (which they did ) it is covered and if it exceeds their expectations on cost they will fight with the hospital and not the patient . I would like to hear of similar cases problems or indeed sucess stories so I can confirm my own findings and be able to quote cases showing what a normal insurance company does with this sort of claim It may help me fight them . ONCE AGAIN IT WAS ING INSURANCE >>>TAKE CARE

It is a little late now, but the fact is, you should gone with the heart by-pass. Although more costly, it would have been covered.

The problem isn't ING. Most insurance companies in Thailand don't cover the implantation of artificial devices, such as pacemakers. If there is any villian in this situation, it has to be the hospital. Since this is not an unsual insurance exclsion, they should have known that this might not be covered and, at least, checked with the insurance company.