Wednesday, October 19, 2011

Chartis Insurance Failure to Pay Reimbursement and many others

Insurance companies are not as trustworthy as before. They take our money easily but fail to reimburse when it comes to claims giving excuses such as non-failure to comply to some obscure terms or information or on a technicality. Chartis, MAA, IHM (now dead), and what other insurance companies? And yet, when Obama bailed out AIA, they have the gall to pay large hefty bonuses to themselves giving excuses that it was in their contract!

I have seen the failure of payment by these money leeching insurance company who find ways and means not to fulfill their obligation. It was so easy for them to say if you sign up for this policy or that policy they will reimburse you when something happens to you just so they can close the deal. But when it comes to actual claim, they will say you didn't disclose this/that, or the illness you mentioned occur on a different date stated or some other technicality. Simply put, they will wriggle themselves out from fulfilling their obligation.

Case A - IHM

This occurred many years ago, when my late father-in-law required a cornea transplant due to cataract due to old age. Now if you understand your medical facts right, cataract is due from UV exposure such sunlight. People who worked under the sun such as farmers, fisherman, laborers, drivers, sales people, will have a higher incidence of getting cataract.

However, my father-in-law has a type 2 diabetic condition. Usually if not careful, diabetes will affect the retina. However in his case, it was more due to exposure to the sunlight UV. The doctor also wrote a report to that effect. However the insurance company refuse to make payment.

It was until much complaint with relevant governmental agency did the insurance company relented but, they only paid half of surgery cost. As they didn't want to admit to the facts.

Because of this incident, many of my relatives who were planning to sign up with this insurance company decided not to sign up. Eventually many people didn't want to sign up with this medical insurance company leading to its demise.

Case B - AIG

My brother-in-law signed up one of those insurance called in via telephone. These policies were usually tied in with the credit cards offering coverage not usually found from those sold by insurance agents. The sign up is usually very quick based on your recorded conversation with them via the phone.

However, six months later my brother-in-law was diagnose with brain tumor and he submitted the claim. This claim happened during the period when AIA in America was having a financial problem due to recession. It was also when Obama administration gave them the bail out money that the board of directors pay themselves big fat bonuses instead of using it to bolster the company finances.

As for the AIA insurance company here in Malaysia, they felt that there was foul play as the claim was made just only six months from the sign up and sent an adjuster to investigate. However all the information from the doctors and medical report indicate it was a real cancer case. But the insurance company made the adjuster checked with 24 hospitals to try to find fault with the medical report to avoid payment, but could not find any loophole.

The adjuster was very unhappy with the insurance company because it made him run to so many hospitals to investigate the medical report. Eventually the insurance company made the payment but they didn't pay in full and deducted the cost of the adjuster fees. They held my brother-in-law to ransom by saying if you didn't accept the final payout, they withhold it for further investigation. It was like a small win for them against the big loss of insurance claim pay out.

Case C - Chartis

So now, here it goes again. A telemarketer from a credit card company called in regarding medical allowance "hospitalization plan" from Chartis via Citibank credit card. He explained that they will pay out without needing medical examination. My brother-in-law explained that he has brain tumor, but the telemarketer says hospitalization plan has nothing to do with pre-existing condition. It sounded too good to be true, so my brother signed up.

So when he was hospitalized and tried to make claim, now the insurance company turned around and rejected his claim and say that he got pre-existing condition and not valid for the claim. Aren't what the sales agent says should hold the insurance company accountable? Mind you the monthly installment was not cheap at RM72 per month.

My brother-in-law now wants to hear the recording of the conversation for the sign up via the phone but I suppose the insurance company would not dig up the recording since it would be to their disadvantage.

So despite telling the truth, the facts now is who is not telling the truth? The insurance company or the telemarketing agent who sells on behalf of the insurance company because he just wants to receive his commission?

Case D - MAA

I had a friend who has been diligently paying his medical insurance for many years. One day he has to be hospitalized for some back ailment. However when he attempted to make insurance claim, the insurance company dug out the old records and told him that the pre-existing condition that he declared was on the wrong year. It was a difference of one year, and how the hell was he to know which year exactly it was anyway? He did tell the truth about his pre-existing condition!

Anyway, the insurance company did not want to pay for the medical procedure, but they would reimburse the arrears of insurance fees that he paid. The fees was not enough to cover for the cost of medical treatment, though they paid the arrears back. I suppose the insurance company looked for a loophole to avoid paying the bigger insurance claim sum by sacrificing the smaller sum of insurance fees.

I don't know why my friend still sign back up with this medical insurance company again, since they played him out and cheated him due to a technicality.

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Although we do need insurance coverage as the cost of medical fees is very expensive now days, however I find their failure to reimburse medical insurance claims did not leave much to be desired. Granted there are some people who would cheat the insurance companies but what happens when the insurance companies cheats their policy holders instead?

My wife said that my insurance coverage is a little low. Then again, if I do have enough insurance coverage will the insurance company pay back as agreed in their sales pitch or find some loophole to avoid payment?

2 comments:

RFKW said...

This article is quite related to a movie my teacher showed us. The movie is called "Sicko" by Michael Moore. It basically also talks on how insurance companies try to cheat and avoid paying their customers.

this is what Obama was trying to fight against, in the new healthcare plan. google up, download or buy the movie. it's worth a watch.

Anonymous said...

I screwed Chartis CSR bcoz their telemarketer not saying truth about my hospitalization plan.