I had my first experience of being hospitalised and making a claim on my MM2H-mandated medical insurance policy earlier this year. I’m only writing about it now because, although my surgery was back in March, it has taken until September to wrap up the whole process.
Luckily it wasn’t anything too serious – but nonetheless a surgical procedure and an overnight stay in hospital were required.
Late last year I had started getting nosebleeds – starting out bad and progressing, over the space of a couple of months, to ridiculous (and quite scary), culminating in a trip to my local Accident & Emergency department. They patched me up but suggested I should see an ENT (Ear, Nose & Throat) specialist a few days later, which I duly did. He took one look and referred me to an ENT surgeon – Professor Dato’ Dr Prepageran at UMSC (University Malaya Specialist Centre), who as it turns out is one of (if not the) foremost ENT experts in the country. I certainly felt in very good hands with him.
Several consultations, tests and scans later, and it was established that I had a large growth that needed to be removed from the inside of my nose, complicated by a heavily-deviated septum. Surgery was arranged for a few weeks later.
The timing was fortuitous, as the global coronavirus pandemic was just starting to take hold and, in anticipation of hospitals being potentially overwhelmed with Covid-19 cases, it looked uncertain how much longer they would remain open for non-emergency surgeries. There was of course the concern that being in hospital would increase the risk of being exposed to the coronavirus, but after discussing this with Professor Prepa, and being satisfied that all the right precautions were in place, I felt it an acceptable risk – and better to get on and get the surgery done rather than spend the rest of the year (and maybe beyond!) dealing with regular severe nosebleeds.
My surgery went ahead uneventfully, and successfully, and I have to say that the care I received during my recovery in hospital was superb. Overall I was very impressed with the quality of healthcare here.
I then had several follow-up consultations over the course of the next few months until I was released from Professor Prepa’s care in June.
There was then the matter of the finances.
The way this works here in Malaysia, or at least with my insurance policy from Prudential, is that most of the expenses are “pay and claim” – I pay the bills and then claim them back from my insurer. The exception was the surgery itself, which they pay for directly (total cost, around 18,000rm). Everything else I paid for and then (eventually) got back – mostly.
Upon each doctor visit, you pay a deposit (300rm on the first visit, 200rm on each visit thereafter in my case). You then pay the balance after your consultation, before leaving – though I imagine you could just walk out and have them bill you, but I’m not sure how advisable that is if you want them to keep seeing you! Obtaining and safely keeping your receipts for everything is vital, as you will need them for your insurance claim. Malaysia is still a very paper-based country, and many of the things I used to take for granted as being done online, electronically, back home, here require reams of paper. I suppose it’s lucky that trees grow quickly in this part of the world…
Once I was discharged, back in June, I set about putting in my insurance claim to have my bills reimbursed. In theory, I could have claimed each bill as I went along, but I felt it would be simpler to wait until the end. And as it turned out, the process of claiming didn’t exactly go smoothly, so it was probably just as well I was only dealing with one.
Luckily, my Prudential agent is superb, and did a lot of running around to get everything sorted out. I’m not sure I would have been able to do it all myself.
The first step is to collate the original copies of all your bills – these need to be submitted to Prudential. I had been taking scans after each visit in any case, in order to have electronic copies for myself, and I’d highly recommend doing this, as you will very likely find yourself wanting to refer back to them later (I use CamScanner app on my iPhone rather than owning a physical scanning machine). I also created a simple spreadsheet, listing for each bill the date, deposit, balance, and total paid, plus brief description, and then giving me the grand total – a little over 7,000rm in my case. Later on, I would find this spreadsheet invaluable for trying to work out What On Earth Was Going On…
With the help of my agent, we filled in the claim forms and handed them in to Prudential, along with the original copies of all the bills. Then waited to find out whether the claim would be accepted.
And waited… Things move slowly in Malaysia and it was a good few weeks before I heard anything back, not helped by it taking a fortnight for a letter to reach me (I don’t know whether that was the fault of the postal service, the letter sitting in an outbox at Prudential, or perhaps it going into the wrong mailbox at my condo, but whichever, I got it just over two weeks after the actual date on the letter).
Prudential did accept my claim, but only paid out about a third of the amount initially. It turned out that, in order to consider the rest of the claim, they needed some further, quite technical, information that I was somehow expected to be able to provide. Now, the simplest way for Prudential to get this information would have been for them to pick up the phone, call the hospital and spend maybe two or three minutes talking to someone there. But no, cannot lah! Thankfully my agent did the heavy lifting here, and went to the hospital in person to obtain the answer and the necessary documentation. Meanwhile, further to a separate request from Prudential, I went back to the A&E department where it had all started in order to obtain various medical records that they needed – there is of course a fee for providing medical records (a few hundred ringgit) but Prudential did at least confirm these would definitely be reimbursed.
Some weeks later, Prudential paid out a further tranche of my claim, theoretically in “full and final” settlement, but still not the total amount I was expecting. I knew there would be some deductions per the policy terms – 300rm for the hospitalisation, plus the ‘administration fee’ (typically 10rm) levied on each visit. But that still left the reimbursement almost 700rm short.
I asked for a breakdown, by invoice and line-item, of what had been excluded, and why. I was sent a letter containing a brief list of bullet points, listing the excluded amounts. Except that very few of these tallied with what was actually printed on the invoices, and no sensible reason was given for their exclusion. After a few hours with my spreadsheet, going back through the invoices, and adding an additional column for administration fees, and splitting out some other details, I was able to – just about – make the numbers tally. I had to make some assumptions about what Prudential meant, and mess about a fair bit with the numbers, but I was eventually able to see how they might have arrived at the amount they were deducting. It was still 20rm off though, but close enough.
I did appeal their decision not to pay out the full amount and, after some runaround, did eventually get an explanation of why they still would not. What had happened was that, after my surgery, I started to get heart palpitations, which I mentioned to my surgeon and queried whether they might have been a side-effect of the general anaesthetic. He immediately sent me off to see one of his colleagues, a heart specialist, who in turn sent me for an ECG. After a thorough check-up, we established there was nothing physically wrong – and the palpitations did eventually go away, although it did take quite a few weeks. Whether or not they were related to my surgery or just coincidence, I don’t know. But Prudential declined to pay for that part of my medical bills, citing terms in the policy that state:
“We shall reimburse reasonable and customary charges incurred for medically necessary follow-up treatment on the life assured by the same surgeon or doctor.”
The key phrase here is, I think, “by the same surgeon or doctor”. Because I’d been referred to a different one, they wouldn’t cover it. I’m assuming there was no issue with it being medically-necessary, as my surgeon clearly felt it was indeed needed.
By the letter of the policy, fair enough. But by the spirit…. hmmmm. I suppose I can see why they might have that clause – perhaps in the past people have taken the p*ss and used the opportunity of a minor surgery to claim for all sorts of unrelated treatments and check-ups. But it strikes me as a little draconian, and something to watch out for. I mean, what happens if your surgeon is away from work, off sick let’s say, and delegates a follow-up consultation to a colleague? What happens if your surgery is complex and requires follow-up with a variety of different specialists? This seems like a pretty big get-out clause for Prudential, and could prove expensive for the customer who thought their ‘medically-necessary’ follow-ups were covered.
I’m not overly concerned about the money – it’s not a huge amount compared to the overall bill. But here’s the thing – for the sake of 700rm, Prudential could have won me over, left me with really good feelings towards them, had me thinking “Wow, Prudential really came through for me, good work”, kept me as a loyal customer for life, and made me a strong advocate for them. Instead I’m left feeling they’re a cheapskate, that they’ve nickel-and-dimed me, that any time in future I need to make a claim, I can expect to have to fight them every step of the way, check every last bit of paperwork, every last calculation, and hold them to the wall to get anything from them. Far from being a loyal wouldn’t-even-think-of-switching customer, I’ll now always have half an eye out for a better deal. That 700rm could easily end up costing Prudential tens, hundreds, of times that in the long run. Good work, Prudential. Not.
That 700rm aside, I got most of my money back, eventually. But coming from the UK, it really makes me appreciate the simplicity of the NHS, where one simply doesn’t need to worry about the bills – it’s all taken care of behind the scenes; “healthcare free at the point of need”.
Luckily my surgery was minor and I was fully recovered by the time I came to deal with the insurance claim. But I can well imagine that for someone with a more serious, or long-term condition, dealing with all this during recovery, or while still unwell, would have hugely added to the stress and worry.
I mean that as not so much a criticism of Prudential (though there is much they could do to improve their internal processes and customer communications – very much), but rather of the whole concept of insurance-based healthcare. Anyone who thinks this is the best way to do things (looking at you, America), has presumably either never had to actually make a significant medical insurance claim, or has never experienced a system like the NHS – which, for all its problems, at least shields the patient from the financial aspects of their care, leaving them to focus on their health and recovery.
Still, all’s well that ends well. And of course, as an expat here in Malaysia, insurance-based medical care is unavoidable. Although I would obviously rather not have had the health issue at all, I’m glad I had this experience now, early on in my time here, as at least I now know what to expect if I ever need to go into hospital again.
As with any insurance policy of course, the proof of the pudding is in the, er, claiming. Prudential could have done a better job. But then again, I’m not convinced they are any worse than anyone else. I think much depends on having a really good agent – so whichever provider you choose, once you’ve compared prices, benefits, exclusions, and terms and conditions etc, make sure your agent is someone you feel good about. They will be invaluable if/when the time comes to make a claim.
Perhaps one day Malaysia will go fully digital, and it will be simple and quick to make an insurance claim online oneself. But for now, it’s very much a manual, paper-based, and above all relationship-based process. In my case, I think it’s fair to say that my agent is the reason I stay with Prudential – if he ever moves to another provider, it’s highly likely I would switch too (which, to me, speaks volumes about Prudential as a business…).
Anyway, in summary, my main takeouts from all this are:
- Be prepared to pay your bills up-front, so keep plenty of cash reserves. You can of course draw down on part of your MM2H fixed deposit after one year for certain medical bills, though I didn’t do this so I can’t comment on how easy or quick that is – I suspect you will still need to front the bills then get the money back afterwards.
- You can pay your bills by credit card, but do take more than one card with you. Having your only means of payment declined at the payment counter before your appointment, even if it was the bank’s mistake and not your fault (yes, it happened to me) is stressful and embarrassing.
- Be prepared to jump through hoops, and do a lot of running around, and potentially some arguing, to get your claim processed.
- Check, double-check, triple-check even, everything your insurer tells you. Just don’t trust them, basically. Sad to say.
- Accept that you’re not going to get back the entire amount you’ve paid out, and probably less than you were expecting.
- A good agent is worth their weight in gold!