Are Insurance Companies Fair to Us?

Posted by Unknown On Wednesday, June 1, 2011 7 comments
Like many Malaysians, I have a medical insurance policy with an international insurance company and pay an annual premium of more than 3500RM. Recently, my agent kindly suggested that I upgrade my current policy so that I can enjoy unlimited claims instead of the current 300 000RM cap.


I gave her a copy of my latest medical report which gave me a clean bill of health. In fact, my medical check-ups for the last five consecutive years (inclusive of scans and ECG) have shown that I have no medical issues whatsoever! However, in 2002, I slipped during a hike and suffered from a herniated disk.

Shortly after that, she said that upon checking with her company, she was informed that I have to undergo a MRI at my own expense to confirm that my back is alright. She said that the exclusion on my back remains and that the exclusion will be removed if I undergo an MRI AT MY OWN EXPENSE to prove that my back has recovered completely.

I have been boiling mad at this scenario because:

  • My accident that led to my back injury happened in May 2002.
  • I did not undergo any surgery then and was only hospitalised for ONE DAY.
  • I did not make any medical claim with this policy then as it was covered under my husband's company's medical insurance.
  • I did not make any claims in post-admission visits to the surgeon because there were NONE.
  • Since May 2002, I have not been admitted to any hospital, neither have I made any medical claims on my medical policy with that insurance company. I have been very healthy till now.
  • I have had no issue with my back from May 2002 till now and have been very mobile, active in sports, hiking and even travelling so often.

Now if I am still immobilised by my back, I would not live such an active lifestyle!

It is REALLY unfair that the insurance company slaps such an exclusion and expects me to PAY FOR A MRI MYSELF AND BE EXPOSED TO UNNECESSARY RADIATION just so I can increase my premium for extra coverage.

If they pay for the MRI, it would be a bonus BUT, knowing that I am fine, I would NOT expose myself to extra doses of radiation. WOULD YOU?

However, if it absolutely insists that I undergo the MRI, I am willing to do so under protest provided the company bears the FULL cost because of the circumstances.

I sincerely hope that insurance companies will put an end to this discriminatory treatment and put its customers FIRST instead of profits and self-preservation motives!

According to THIS SITE:

A pre-existing condition can affect your health insurance coverage. If you are applying for insurance, some health insurance companies may accept you conditionally by providing a pre-existing condition exclusion period.


Although the health plan has accepted you and you are paying your monthly premiums, you may not have coverage for any care or services related to your pre-existing condition. Depending on the policy and your state’s insurance regulations, this exclusion period can range from six to 18 months.

In my case, my injury occurred more than ten years ago and it is TOTALLY UNFAIR!

Does anyone out there have any experience/advice to share with regards to such exclusions? I am submitting my letter of appeal and will definitely fight for fairer coverage! Please leave a comment to share your views/input/advice. Thanks!

7 comments to Are Insurance Companies Fair to Us?

  1. says:

    TO We must understand that insurance companies exisit for their own benefits FIRST and foremost! And for their share-holders. In the event one has to make a claim for medical insurance they will try their utmost best to disqualify your claim and not to pay you! Luckily for me I don't really need private medical insurance - I hope I can rely on the NHS when I need to.

  1. says:

    edward Yes, one is only good for them when young and healthy. They will kiss the ground you walk on just to get you to sign a policy with them. Once you have a blip in your health status they will shun you like a skunk.

    I have had my premium raised from an initial RM3k+ to RM15k+ because of a past medical condition. It was a requisite before a loan can be approved. Although they had approved the insurance policy and even collected the first annual premium, they went back on their word because of greed. I told the bank and the insurance company to go fly kites. They refunded my paid premium but through the bank informing them my refusal to fulfill the requirement. After 3 years I settled the entire loan, and even paid an early settlement penalty. Needless to say I will never step foot into that bank/insurance company and discourage any of my friends from dealing with them.

    Do ask your doctor whether an MRI is absolutely necessary or whether a medical report is sufficient. If it is required and you choose to do one, do not worry about the radiation as MRI uses magnetic resonance and is not harmful. As for me I will show them my middle finger and take my business elsewhere. Pardon my language.

  1. says:

    UP41 Dear MWS, The gov is following or mimic the America system of health care which benefit the medical / hospital and insurance companies at the expenses of the people. The result is high medical cost per head in the world but not necessary high medical care standard. Few USA presidents had in the past tried to change the system but with little success.

    Blame & curse the insurance companies PLUS the gov that is behind them.

    Very soon we could afford to mati , but not sakit.

  1. says:

    Unknown Dear TO, Edward and UP41

    Many thanks for your sincere responses, shared experiences and sharp observations about the insurance industry.

    I am quite rattled that the government has not really scrutinized the conditions laid down by these companies.

    As such, it appears that we will always be on the losing end unless there can be a breakthrough of some sort.

    I have submitted my letter of appeal and will update when I get news from the company.

    Take care and thanks again for your passionate responses.

    Have a lovely weekend!

    Warmest wishes

  1. says:

    LC Teh I never had much faith in insurance. Maybe it's my dad's influence... I'd rather start at around age 40 to put something like a health insurance premium into my own FD account. Let's say, my premium is RM3500 per year. By age 50 I'd have an amount that should cover even a major operation if my health does go downhill. And hospitals, I'm told, don't hike the costs if one pays cash.

    Nope, insurance companies are out to make money. It's 100% business. And private hospitals are also business entities. It's now 'Health-care Business' not hospitals...

  1. says:

    Unknown Dear LC Teh

    Very valid points and I wish I had known you years ago. Then I would not have wasted my money only to be disappointed. You have much wisdom, my friend! Thanks so much for such a wise and passionate response. Take care and God bless you. Stay in touch!

    Cheers

  1. says:

    Anonymous Hats off to you! you have shared an amazing information!! Thank you for the great share! Eob insurance

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