This is quite an unusual scenario where a man in his 40’s, Stephen Ng, has prostate cancer. Apparently, he wrote a letter to Tan Sri Zeti some time ago, then 2 opens letters which got published at FreeMalaysiaToday and Malaysiakini when Zeti didn’t respond. Anyway, the man’s urological surgeon suggested that he should avoid surgery, because radiotherapy and hormonal treatment is less invasive and will give an equally good outcome. This would cost Stephen about RM33,000.
You can read his original letter HERE.
A medically sound decision, yes, but after consulting his insurance company about the medical treatment, Stephen was told that, while a surgery can be covered up to RM400,000 (not a mis spell), the treatment package suggested by the oncologist is considered ‘Outpatient Treatment’. For the record, any surgery is considered at “Inpatient Treatment”
Because of the advancement in medical technology, both hormonal treatment and radiotherapy does not require surgery.
What does this mean for Stephen’s pocket
Stephen was pissed (anyone in his shoes will) as he has been paying an annual premium of RM1,400 for the medical policy the past 12 years, only to discover that it only has a cap of RM10,000 (a whole lifetime) for outpatient treatment.
This means that if he were proceed with the radiotherapy and hormonal treatment, he need to fork out another RM23,000 provided that the other prostate cancer related scans that he did earlier has not eaten into the lifetime outpatient allocation of RM10,000.
Watch this video for better explanation from me
From a consumer standpoint, it is totally understandable to think it is absolutely ridiculous that the insurance company should determine the payment based on whether it requires surgery or just outpatient treatment.
Stephen commented “By setting a cap to ‘Outpatient Treatment’ using the fine prints, especially for anything to do with cancer treatment, is simply cruel.”
What is my take on this & how I could help
I can tell Stephen that this is not a fine print but it is how medical cards products are being designed. I wrote a reply to his letter, which didn’t get published at Malaysiakini but got published in FMT. See below.
I know exactly which insurance companies has this “unfavorable” feature but I cannot disclose this in the public lest getting a cease-or-desist order by the insurer.
If you feel this is important to you and need independent advice on which company to avoid and how to check your policy if it has a separate cap on outpatient limit…
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Knowing this would saves your thousands further down the road, preventing unexpected surprises like what Stephen experienced. To add up to the physical pain, wallet pain is something we could avoid if we know how to manage this.