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How I managed to claim $21,900 from my Insurer – even before my Policy was active

Posted 16 March, 2017 by Clearly
in Guest Contributions

*This is a story contributed by Donald Lee, who helped his client claim all her medical and hospital bills – even though the policy was not fully inforced at point of diagnosis*

 

In this industry, we are often thought of as pushy and “sales-only” oriented. Which is really a negative image that all financial planners must work together to overcome.

What we are really fighting for, amidst all the “pushiness”, is such that we secure our clients before they are visited by misfortune.

Alice (not her real name) was one such client of mine. She bought an Integrated Shield Plan with a full rider in October 2012. The basic plan and rider would have enabled her to receive treatment and claim for any hospitalization-related bills in any hospital, including a private one.

People often feel that insurance can always “wait for another week”.

In this case, if Alice had waited for another 7 days before buying the plans, she would have been $21,900.81 poorer.

 

Policy bought but not in-forced yet

 

I submitted her proposal form for the Shield Plan and rider, which was accepted on 16th October 2012.

The next day, the cash component of the plan (The rider) was fully in-forced. But the MediSave payable component of the plan (The main plan) could only be in-forced on 1st November, because back then it was the practice of CPF to only disburse the funds on the 1st of every month.

 

A routine check came back with serious news

 

Alice then went for a routine annual company check with included an ultrasound of the pelvis – on 20th October (before the main plan was inforced)

The doctor detected signs of cyst formation in Alice and quickly referred her to a specialist for further diagnosis and treatment. (Editor: Cysts are sac-like structures that can be filled with fluid, pus, or other gaseous material. They are usually benign, but can indicate an underlying medical issue.)

 

Immediate Surgery was recommended

 

Upon consultation and a second ultrasound scan with the specialist, Alice was recommended to have an operation to remove the cysts immediately. She saw the specialist on 5th November and surgery was scheduled on 14th November. (Ed: Note the urgent nature of the op)

Alice was warded in Mount Elizabeth Hospital from 14th to 16th November and the immediate hospital bill came to over $19,800.

 

Screen shot 1 of 3: Bill from Mount Elizabeth Hospital

Screenshot 2 of 3: Bill from Mount Elizabeth Hospital

Screenshot 3 of 3: Bill from Mount Elizabeth Hospital. Note the total estimated bill

Worried sick about the claim

 

Post surgery, there were follow-up consultations and additional bills to be paid for. It was then that Alice contacted me about the claims procedure. She was worried that since the diagnosis was made even before the main plan was inforced, the claim would not be honoured.

It was certainly a very delicate situation. A mere days after policy application, the life Insured suddenly had to undergo a major operation. I knew the key to this was a clear line of communication between the doctors and the insurer.

And we got down to work.

The first step was to get a doctor’s statement –

 

 

– and attach the details of the surgery –

 

– followed by the actual claims submission.

 

 


Picture10

 

 

One week did make all the difference

 

The story ends on a happy note. The Insurer paid out all related claims totalling $21,900.81 to Alice.

 

The deductibles and co-insurance of $4,681.54 were reimbursed separately (next image)

 

The co-insurance amount of $208.53 was reimbursed separately (Next image)

 

What swung the case, other than the timing? (Ed: I doubt the claim would have gone through successfully if the inforcement date of the rider was after 20th October)

In my opinion, it was the prompt submission of the claim, coupled by the fact that both doctors attesting to the genuine lack of awareness of the patient. (Due to lack of symptoms)

Afterall, she was only 27 years old at that time – an age that most of us would think ourselves in the pink of health. Who would suspect cyst formation at that age?

 

My message to everyone reading this

 

Please, give yourself and the insurer a fair chance. Some people avoid insurance because they think it’s a scam or companies are out to cheat them of their money. This story shows that as long as the circumstances are genuine, the insurer will pay out according to the terms set forth.

Having a responsible agent is crucial. They know the conditions for claims payout, they are in the business of dealing with claims officers day in and day out.

If you are considering to buy your own insurance, it is certainly a good idea but having a good agent on your side can make all the difference in the world. For Alice, this claim amount already represents the next 25 years of premiums to be paid. And to this day, she still enjoys the same cover from the plans.

And finally, please do not put off buying insurance. Misfortune can strike at any given time, so the one week, or even one day that you wait might cost you dearly.

More than you can ever imagine.

 

Editor’s Closing

 

We thank Donald for taking the time and effort to share his story and the relevant details to us. We hope that through this, more and more readers will take positive action and prevent a financial catastrophe from happening.

 

About the Author

 

 

 

Donald is a practicing Certified Financial Planner in the financial advisory industry and has been speaking actively on the topic of personal wealth management. Some of the companies that he has spoken for include Great Eastern, 8I Education, and World Vision Singapore.

Donald is a top adviser from his company; a value investor and a certified estate planner. He takes a practical and simple approach towards planning. To date, he has underwritten easily more than $500 million worth of insurance coverage for individuals and companies.

And he still feels that is not enough.

Contact Details

Donald Lee Jianxing

Tel: 9125 5137

If you have a story to share, we would love to hear from you as well! Reach out to us here.

 

www.ClearlySurely.com aims to eradicate the knowledge gap between consumers and Life Insurance. Our Vision is that one day, every Man, Woman, and Child will be properly insured.

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