[MERGED]Medical Card/Insurance Kesihatan...... What U should know...

Di bawah adalah explanation daripada seorang agent from one of the reputable company,,bukan senang2 nak masuk ,,tunjuk2 kad je leh masuk,,ada beberapa procudure perlu di lalui..

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eise,

Thanks for the xplanation. But in reality, have you ever come across to any real-life-situation admitted to a hospital? Well, been there.. done that. Infact dah 3 kali dan yang terbaru baruuuu je minggu lepas.

I akan ceritakan dari 1st step. Tapi kita cut short sikitla, whereby you memang dah sakit sangat, dan perlu diadmit ke hospital. First you kena pergi ke klinik dan mnta direferkan ke hospital. Atau mungkin boleh pergi ke bahagian pesakit luar. Bila dah jumpa doktor di hospital, doktor mengatakan you need to be admitted. Only then kita akan lalui proses admission to ward.

A good hospital service, akan ada somebody assist you to admission counter. Disaana dia akan tanya samada company or self or insurans pay. Let say you ada medical card, tunjuk card dan dia akan faxkan 'GL' to insurans office. Munkin memakan masa, tapi selalunya diorang akan state 'pending GL' dan kita tak perlu tunggu, dan boleh masuk wad. But before that, you must pay some deposits for admission.
bla..bla..bla... time check-out/discharge, diorang akan preparekan bil dan kita akan selesaikan di payment counter. Bayarlah apa bayaran yang dikenakan. any outstanding bills that are not covered by the insurance company, diorang akan mintak bayarla... if not tiada bayaran diperlukan.

if let say ada hospital benefit yang lain, selalunya you need to inform the agent, dan agent akan buatkan any claims such as Hospital Daily Allowance benefit (at least for Prudential)...

[ Last edited by  eise at 6-6-2006 05:16 PM ]

honeybee1802

Originally posted by sapubersih at 6-6-2006 12:47 PM
Unlike your frens punyer experience, most of my fren told me not to go to SJMC. But memandangkan at that time SJMC has the best Pediatric specialist, I pegi gak....

bukan masalah medical kad but ...

oo..this kind of stupid fella kat admission le nih.because my family n i never encountered such exp.first time tuh g emergency the doc n nurses just treated my son n then br g admission.(ms tuh tak ramai org).she asked me which room i like.i said kasik je yg mana fit ngan medical card tuh.ngk rm150 dia ckp leh le msk single.i pun ok ler...penah gak g yg pediatric tuh.bwk ref letter ngan card,minah tuh mcm malas skit.i said b4 this i bwk mende tuh jek setel.

erm..nak beli MC nih mcm shopping around gak..bare in mind if u got a certain chronic disease baper estimate blanjer u.sbb penah i ngk satu plan..max sampai rm450k...but..limitation dia byk woo...u got cancer...operation sekian ribu, chemo sekian ratus up to baper kali....pergh..mana muat tuh...

blackmore

Originally posted by sapubersih at 6-6-2006 12:47 PM
Unlike your frens punyer experience, most of my fren told me not to go to SJMC. But memandangkan at that time SJMC has the best Pediatric specialist, I pegi gak....

bukan masalah medical kad but ...

...frustrating and annoying isnt it when we come across staff who doesnt noe their job well...who do not even have any initiative and most importantly staff that dont even noe how to respect and treat their customer rite...

...i can emphatise with your situation...but..i do not see the rationale of settling your issue by shouting and farking back at them...heh...to me...orang2 sengkek jer yang behave this way...bila dipandang rendah they start to use vulgarities and flashing their credit cards and cash...and telling the whole wide world who they are...on the other hand...orang2 yang tak sengkek are the ones yang able to maintain their cool  but at the same time able to fark these pple back...

...ps...beb..mana2 kita pi pon kita akan jumpa spesis macam gini...yang suka pandang rendah kat orang lain...but...i always believe that pple cant look down on u without your consent...so...dont give them that opportunity...chill yeah beb.....

sapubersih

eise,

The situation was an emergency, my 2 year old daugther was diagnose as having lung infection. Believe me this is serious kids or toddler can die if no immediate medical attention is given. I can wait for the status to be cleared is because they have started given her the antibiotics prior attending to the admisssion counter....but I was definitely disappointed to know that at first look she has look down on me when I wasn't bragging at all.

Somehow, when I rushed to Gleaneagles, at the flashed of the card in 30 minutes, my daugther was admitted....ain't that give you some ideas abt SJMC?

honeybee1802

sapubersih,did u remember the staff name or what?if so,then i think you can make a complaint...

sapubersih

Black,

It is not abt being sengkek or not and I wasn't at all times showing off or bragging. She on the other hand at the first look already look down on me. Well, even that i wasn't paying any attention bcoz my focus was to get my toddler admitted. That was my main focus-medical attention.

Believe me when I shouted at her & the manager is just bcoz my heart-felt was having a deep cut bcoz they are treating my daughter's case as just a simple non-emergency case. i can't believe there are hospital who behaved this way.

Unlike your statement, on that day 2 VIPs shouted at the doctors and other staffs for reason I dun care to take note. The 2 VIPs are driving an X5 and a Merz S280. A not sengkek fellas. Unlike me I just not a sengkek but not a VIPs.

Your reasoning abt only a Not sengkek fella who shouted because they want attention, you are wrong beb... my disbelieve was i have strong argument wif my wife abt bringing our daugther to SJMC whilst she wanted to go to Gleneagles. After putting such a strong belief abt SJMC and their best Pediatrics, i have to go throught this....you tell me which father will not get angry.

You need to learn psychology before becoming a good doctor if that is your profession. My apology for my ignorance if I am not aware if you are not.

Ingat org suka2 nak marah just to get attention....think and use the head. When we go to hospital it is serious and maybe you are not a father yet or already a father but dun have kids who are in a serious emergency cases. I have 3 children and 2 of them gave us a scare including this incident. My first we almost lost him after 5 days of birth..luckily we are fast enuf to notice that save his life...and this one also...my brother's in-law just lost their son due to Lung Infection.

You tell me if anybody will be in their right mind to just come to a hospital with a vision to fark off hospital staff? Get your facts right buddy....

sapubersih

honeybee,

Yes perfectly remember her name but I am one person who dun like to kacau periuk nasik org eventhough she did that to me....just blow at her face is enuf for me....then never come back...

I can still remember her name and face till today.

blackmore

Originally posted by sapubersih at 7-6-2006 09:56 AM
Black,

It is not abt being sengkek or not and I wasn't at all times showing off or bragging. She on the other hand at the first look already look down on me. Well, even that i wasn't paying any  ...

...fuuhhhh!!...so much angst!!...relak arr beb...

...jangan salah faham ye encik sapubersih...aku bukan memandang remeh pengalaman ko tu...tapi i think there are other ways untuk tackle this situation...just like u said...kena blajar psychology...heh...

...eerrr....aku tertarik hati bila ko mention 2 vips behaving the same manner...eerr...ingat vip nie semua baik ke??...beradap ke???...heh...most vip lah orang2 yang sengkek...sengkek dari segi character ye...bukan segi wang ringgit...tu yang aku maksud kan when i said orang yang tak sengkek jer yang bley maintain their cool but at the same time can fark these pple back...give them nice and proper...heh

...whatever it is...kalau aku ada in any way offended ko...aku mintak maaf beb...:tq:

sapubersih

kita salah faham nih...tak menjadik hal....but truly, bila hati dah kemaruk, kelam kabut n suddenly you are being told there is no room after waiting 3 hours when they shud have told me earlier....hati sapa tak marah...

Bukan sbb penat tunggu..but we are talking abt life n death..tu yg aku tak paham why they kenot tell me earlier that there is no room available...

I din flashed my Credit Cards...tu bukan credentials...tu credentials for kaki utang...hahahahaha..

Cakkkk....aaaa

Huhhhh...kalau betul la 3 jam menunggu...aku pun leh naik angin ....


Apatah lagi kalau benda ni berlaku  kat well known, presumably one of the best private hospital.....SJMC


But these thing selalu jadi la.....

Ingat tak kes ada budak india (maaf sebut race).... kena tikam kat area USJ (deme kata kena rompak).....so the girlfriend bawak gi SJMC and produce the MC......dan kes yg sama jadi mcm 'sapubersih'.....kena kasi DP la....deposit la.....which is illogical considering the fact that the MC entitles them immediate admission if necessary, the case is life threatening, it was at 2am with all ATM were in 'sleep mode'....

And the boy later died on the way to the nearest gov hospital (UMMC- which was not so near anyway)....

And the investigation concluded that the registration counter officer is to be blamed...(I dont know whether "she" was di kambinghitamkan or not..)


Some people react differently while stress up.....be it sengkek, alim org whatever description u may give them.....it all come down to individual stress tolerance level.....

So in sapu bersih case.....i do  not solely blame him.....with his kids life at stake....he deserves to be treated more professionally.(that if only his story is true and nothing but the truth)

sapubersih

Cakkkk...aaaaa...demi Allah it is all the truth and nothing but the truth...

haku ni bukan suka buat2 citer for something which is serious like dis one.....nak aku swear depan Quran yg terbuka pun I will do it....sbb this event really happens to me...leh tanya my agent also...dia siap kelam kabut tolong aku aritu....what a great agent....siap dia mintak maaf kat aku walhal dia tak bersalah pun...

blackmore

...heh...ada sekali tu...aku bawak anak aku pi a&e dept sebab dia semput...that time...cuma aku ngan dia jer...naik teksi sebab hubby aku time tu takde...so...aku angkut jer anak aku pi spital...dalam teksi dia relak jer...tapi tak larat nak bebual...cuma his finger tips semua dah nampak cam bluish sikit...

...sampai jer kat a&e...apparently dia pey sp02 was very low...tak ingat brapa sebab the nurse on duty suruh aku pi register for number...then dia trus bawak masuk anak aku pi kat satu bilik...aku ingat nak kasi ventolin kapa...rupa2nya the whole team on duty dah keliling anak aku...setting drip...kasi oxygen...kasi iv aminophylline (tuk open up his airways) taking blood lah...kat anak aku dah siap pasang wire itu ini...and then came the radiographer...nak buat portable chest x-ray...

...adehhhh...aku apa lagik...trus breakdown kat situ jugak...dah lah aku alone...dorang sikit explanation takde kat aku...tup2 trus anak aku dorang bawak pi kat high dependency ward...happened so fast...less than 30 minits anak aku dah masuk HDU...huhuhu...

...it was only after dorang tengok aku melalak baru one of them datang and explained to me what was going on...huhuhu...disappointedlah beb cos walaupon keadaan time tu kecoh...tapi...dalam banyak2 personnel tu...aku rasa at least sorang manusia bley lah kept me informed of what was happening...and not just left me outside the room wondering what the hell was happening to my son...

...i appreciate their promptness in handling my son's condition...and really...aku very2 thankful to them for that...but...i think they can do better kalau they didnt exclude that human touch...:love:

sapubersih

blackmore,

very much agree wif u..sometimes they just ignore the guardian camtu jek...so far, layanan mana2 pegi swasta or govt hospital treatment are the same coz most of them came from govt hospital so terbawak2 budaya hospital kerajaan....

Originally posted by Cakkkk....aaaa at 7-6-2006 12:51 PM
Huhhhh...kalau betul la 3 jam menunggu...aku pun leh naik angin ....


Apatah lagi kalau benda ni berlaku  kat well known, presumably one of the best private hospital.....SJMC


But these thi ...

Mostly hospital sangat stright dan polisi hospital tersebut perlu kan deposit juga untuk admit ke wad..memiliki madical kad ada sedikit kelebihan berbanding yang tak de,,bukan semua medical kad tak perlu bayar deposit,sesetengah MC kad holder perlu mendahulukan deposit dan claim balik.,,sesetengah kad tak perlu kan deposit setelah mendapat guarentee letter daripada organisasi yang menguruskan kemasukan ke hospital..as a card holder perlu clear benda ni, takut lepas ni dok blame insurans perubatan (MC) kalau berlaku perkara di luar jangkaan akibat daripada tidak memahami sepenuhnya ciri2 kad tersebut.

sapubersih

Ni nak politely lar..bukan menghentam..

then what is the purpose of Medical card then...?? Guaranteed Letter kira dulu2 pun dah pakai...so, kalu MC dah tak laku n still kena gak bayar deposit then what is the purpose?

Quite normally banyak insurance company yg offer 2 different way of admittance. Satu Non Cashless Option and satu lagik Cashless Option....like me I definitely tak nak berada dlm kesusahan nak singgah bank kuar duit ketika dlm kecemasan..so I opt for Cashless Option...but cashless option ni premium dia lebih dari non cashless option...so, tu pasal I tanya What is the purpose for the MC then?

Someone need to raise this with either MMA or PIAM or LIAM and force them to work a way that Hospitals will accept MC regardless whether they are strict or not...agree or not?

Ni nak politely lar..bukan menghentam..

Tak pe i jawab setakat i mampu

then what is the purpose of Medical card then...?? Guaranteed Letter kira dulu2 pun dah pakai...so, kalu MC dah tak laku n still kena gak bayar deposit then what is the purpose?

Medical Kad,adalah insurans perubatan untuk melindungi kos perubatan (pembedahan, ubat-ubatan dll) deposit adalah sebahagian dari pada jaminan kepada hospital dan purposely MC bukan untuk elekkan deposit,,tetapi untuk mengelakkan kos perubatan yang mahal,yang terpaksa di tanggung oleh individu berpuluh atau beratus2 ribu..tu tujuan utama MC

Quite normally banyak insurance company yg offer 2 different way of admittance. Satu Non Cashless Option and satu lagik Cashless Option....like me I definitely tak nak berada dlm kesusahan nak singgah bank kuar duit ketika dlm kecemasan..so I opt for Cashless Option...but cashless option ni premium dia lebih dari non cashless option...so, tu pasal I tanya What is the purpose for the MC then?

Kita ada choice, pilih la yang cash less banyak company yang offer,,bukan u sahaja yang amik cash less MC,,i sendiri pun dan ramai lagi kat luar pun pakai cash less MC..

Someone need to raise this with either MMA or PIAM or LIAM and force them to work a way that Hospitals will accept MC regardless whether they are strict or not...agree or not?

Kita sebagai pengguna mmg nak tunjuk je MC dan  hospital benarkan masuk..tetapi kalau bagi pihak hospital you mesti nak make sure kad tu masih aktif dan sebab kenapa kena masuk wad tu mesti tidak termasuk exclution yang ada dalam polisi,, sebab kalau org tak terus bayar premiun pun still lagi boleh ada kad tu tetapi kad tu tak aktif.,, so kena la confirmkan dgn pihak berwajib dulu..agree or not..??

[ Last edited by  eise at 7-6-2006 04:08 PM ]

sapubersih

eise,

agree but soalan nyer di sini why insurans kampeni go all out with the cashless option if they can't even convince the hospital to accept the card...remember in my case in SJMC? I tak kisah if hospitals want to check with insurance kampeni but berpada2...dah dpt confirmation they hide it and still insists on cash deposits. So what is all the purpose of having a MC.

I tau pasal perbelanjaan hospital tuh...ada MC ker takde MC ker we can still claim from the hospital as long kita masih aktif membayar premium...jgn terpesong from the original point here...tu yg I nak tau tu...

My big question here is kenapa sell cashless option when we still have to fork out deposits. Dun Insurance kampeni shud have made that connection with the hospitals before they launch this?

Please eise try to jwb professionally coz I am in the Insurance line infact Reinsurance line. Ofcourse on the direct underwriting I tak tau apa yg diaorg buat but I faced this problems already jadik kenapa teruja nak jual cashless option when they know hospitals can't accept it.

It is quite stended lar kalu they want to check but why still insists on cash deposit when the kad still valid and laku?

You as an agent shud give this kinda feedback to your principal supaya they know when to raise this questions dgn MMA, LIAM or PIAM....if U as an agent kenot bring up such issue sapa lak kita yg suma ni as pengguna....betui tak?

As an agent you should listen to problems that arises jot it down and bring it up to the principal...ni kalu dok pusing round about how am I as a client want to be totally confident of such service.

now please dun take this as menghentam, I am informing you how to become a good agent. itu pun kalu berminat to hear.

agree but soalan nyer di sini why insurans kampeni go all out with the cashless option if they can't even convince the hospital to accept the card...remember in my case in SJMC? I tak kisah if hospitals want to check with insurance kampeni but berpada2...dah dpt confirmation they hide it and still insists on cash deposits. So what is all the purpose of having a MC

Cash less medical kad or haslee free medical kad..i tak tau MC insurans company lain wajib ke tak bayar deposit..but MAA selepas dapat confirmation daripada Mediexpress dan mediexpress fakskan GL ke hospital tersebut,,tak perlu bayar deposit beribu2, maybe hospital akan mintak 100-200 untuk deposit bukan perubatan

I tau pasal perbelanjaan hospital tuh...ada MC ker takde MC ker we can still claim from the hospital as long kita masih aktif membayar premium...jgn terpesong from the original point here...tu yg I nak tau tu..

Insurans perubatan ada yang tak de kad dan ada yang pakai Kad..sebagai pengguna kena kena tahu membezakan..MC ni invoice bil perubatan hantar terus ke Insurans company tanpa perlu induvidu tersebut pening2 kepala nak cari duit bayar bill..

Non medical kad pulak u kena bayar dulu dengan duit sendiri dan claim balik dengan insurans company.

My big question here is kenapa sell cashless option when we still have to fork out deposits. Dun Insurance kampeni shud have made that connection with the hospitals before they launch this?

Sekarang ni pun Manage Care Organization yang menguruskan cash less MC ni untuk deal dengan hospital 24 hrs ,,MAA mediexpress dan prudential SOS dan banyak lagi

Please eise try to jwb professionally coz I am in the Insurance line infact Reinsurance line. Ofcourse on the direct underwriting I tak tau apa yg diaorg buat but I faced this problems already jadik kenapa teruja nak jual cashless option when they know hospitals can't accept it.

Bagus la u dah dalam line insurans, sepatut nya u lebih tahu kot benda2 ni,,dan ejen u sure dah bagi tau perkara ni dengan detail..

It is quite stended lar kalu they want to check but why still insists on cash deposit when the kad still valid and laku?

To depend kepada insurans companay dan MCO yang uruskan kemasukan hospital..MAA GL deposit RM 2500 yang lain i tak sure

You as an agent shud give this kinda feedback to your principal supaya they know when to raise this questions dgn MMA, LIAM or PIAM....if U as an agent kenot bring up such issue sapa lak kita yg suma ni as pengguna....betui tak?

Sekarang ni Bank negara menyediakan biro pengantaraan kewangan http://www.fmb.org.my/ ,,pengguna boleh mengutarakan complaint dsb..bagi saya procedure sekarang adalah normal, kena cek dulu pas tu tgu GL n admit..

now please dun take this as menghentam, I am informing you how to become a good agent. itu pun kalu berminat to hear.

I mengalu-alukan komen dan cadangan to share dengan forumner kat sini..

[ Last edited by  eise at 7-6-2006 06:01 PM ]

Cakkkk....aaaa

Good info eise...

actually masalah sebenar dengan MC ni berlaku di peringkat pelaksanaan....


Cthnya masalah bahagian pendaftaran hospital utk mengambil inisiatif bagi memeriksa validity MC

Masalah dengan online validity status...kadang2 sistem down...

masalah dengan pesakit yg tidak memahami coverage yg dia layak...

Masalah dengan agent (yg tidak beretika) yg salah memberi maklumat tentang coverage tersebut ... (agent kata tak perlu bayar deposit sedangkan dalam agreement kata perlu bayar deposit minima)

So bolah dikatakan apa yg selalunya terjadi adalah technical glitch walhal sudah ada hitam putih tentang coverage dan prosedur yg di lalui....

Dan bilamana sesuatu melibatkan kesihatan dan nyawa....people will notice it easily......berbanding dengan insurance coverage barang, kenderaan dsb...


Just my 2 cents...

Originally posted by Cakkkk....aaaa at 7-6-2006 05:00 PM
Good info eise...

actually masalah sebenar dengan MC ni berlaku di peringkat pelaksanaan....


Cthnya masalah bahagian pendaftaran hospital utk mengambil inisiatif bagi memeriksa validity MC
...

Yes Cakkk..aaa..perkara ni biasa berlaku

Ramai yang hentam insurans company dan Manage Care Organization sendiri  sebab salah faham..cuma kita sebagai pengguna perlu tahu hak2 dan apa yg sebenarnya kita miliki tu...scope dia limitation dia ...sebab semua tu dah tercatat dalam polisi..dan teknikal nya perlu di beritahu oleh ejen...