One thing you should know about your company outpatient medical insurance

If you are an employee, it is likely that you have a group medical insurance policy borned by your company. Nowadays, this insurance coverage is normally outsourced to insurance companies. For instance, it’s AIA for Intel and Motorola Solutions, and Great Eastern for Agilent Penang. This coverage includes outpatient medical consultation at a list of panel clinics or hospitals; I’ll call it The List here. If your medical treatment or consultation is not at any of these clinics or hospitals, then you need to pay from your own pocket.

 

Sometimes, you discover that the nearest clinic to your house is not under “The List“. Have you ever wondered why?

 

My first impression is, the clinic is just not good enough or not “popular”, for the lack of a better word.
Boy, was I wrong!

 

Your neighbourhood clinic is likely to have been approached by the insurance companies to be included in The List. And you are probably not the first person to request your company HR to include the clinic in The List.

 

To be included in The List, insurance companies need the clinic to comply to, among many things, a package which states what medications can be prescribed to patients. Main reason is to save cost; else insurance companies would not be profitable. There is also a limit cap of the total medical bill per visit, but this affects patients to a lesser extent compared to the limition on the type of medicine prescribed.

 

A minority of the doctor, however, feel that this is neither ethical nor fair to patients. Deciding on the best prescription should be soley a doctor’s professional judgement, not by insurance companies. Therefore, such doctors decide against the inclusion of their clinic in The List. Now, such doctors should get some respect from us because doing so means losing potential businesses. A multinational company normally consists of thousands of employees.

 

I am not saying that clinics that are in The List are not ethical. I am sure that despite certain restrictions set by insurance companies, doctors will try their best to prescribe medicine in the best interest of patients. However, I am sure we have heard and seen cases whereby our friends or colleague complained that the medicine prescribed by certain clinics are not effective. As a result, we refrain from seeking medical treatment from such clinics in the future. I could speculate that these scenarios could happen when clinics are trying to achieve a bigger profit margin. Of course, there are many other factors leading to this, including one’s body suitability to certain medicine, especially if your doctor is new to you.

 

What is your view on this?

 

*This is the author’s own account on this matter when he went for Hepatitis B booster dose recently at a clinic which he has not visited for more than 6 months after joining a new company.

 

Side note: The government recently proposed 1Care social health insurance for all citizens, which is more or less similar to what was described above, albeit on a larger scale. Read my guest post on this at KCLau.com, 1Care National Healthcare Proposal: How would it benefit Malaysian citizens?
If you are out of options or confused on which medical cover to choose, here is the latest compulsory of the best medical cards in Malaysia.

This Post Has 6 Comments

  1. I’m going to panel clinic and so far the doctor is quite okay. However, not all of them are good. I’ve experienced a lousy doctors before because they can’t answer my technical questions related to their own specialty. I think that still depends.

    For non-panel clinic, it is still covered by my company’s insurance. It just that you need to pay first, then claim it later.

    1. That’s true ChampDog. This particular non-panel clinic I am referring to above has a doctor which draws illustration to explain sore throat 🙂 .
      Yea, mine too but it is subject to limit cap of RM 40, and co-payment of 10% of the expenses incurred.

  2. Hi LCF,

    Nowadays, profit margin means much more than the lives of the patients. I sincerely hope that the doctors can cater more for the patients.

    Thanks for sharing your thoughts.

    Dave

    1. Hi Dave, you got some very unique posts there! I like your illustration in “Everyone is a Boss” & “6 mistakes in property investment”. Never thought of including a blogroll?

      1. Hi LCF, thank you for your kind words. I will be adding you in the blogroll. Do include my site into yours as well. Lets exchange articles and share with our readers. Cheers!!

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