![](https://i.imgur.com/CLvY2jA.png")
29-05-2023, 06:56 PM
My friend told me he face this issue for his coporate insurance claim.
For panel of gp clinics, it is as charged and cashless. For visits to specialist, 1 year can claim maximum $500. He has used finish the $500 specialist claim.
So he went to visit the panel of gp clinic on the 4th May. This claim is approved.
The clinic doesn't have the medicine. So the doctor write a prescription for him to buy it. He took the prescription to sgh pharmacy to buy it.
When submitting the claim, he attach doctor's prescription and invoice from sgh. He submit under panel of gp clinic. In the remarks, he write very clearly this is a follow up from 4th May claim to panel of gp clinic and tell them to see the doctor prescription which is attached.
To his suprise, the claims dept change the claim to be under specialist visit and rejected it. Remarks write claim is rejected as specialist limit of $500 has been used up.
Last week he call the cs. Explain to them this should be under panel of gp clinic claims and not under specialist claim. Also told them he has clearly attached the doctor's prescription from the panel of gp clinic.
Cs tell him they will feedback to the claims department on this.
Today he call the cs again to check on this claim.
Cs: the claims department has gotton back. It is rejected as your specialist claim amount of $500 has been used up as you bought the medicine at sgh pharmacy.
He: last week i told your cs colleague that this claim is under the panel of gp clinic. The clinic don't have the medicine so the doctor write a prescription for me. I bought the medicine at sgh pharmacy.
Cs: i understand sir. The claim invoice is from sgh.
He: so are you saying that in the future, when the panel of gp clinic write a prescription for me and i buy the medicine at sgh. Than it will be classified as claiming from specialist?
(Obviously this doesn't make sense)
Cs: ok i will feedback to the claims dept on this
He: last week i call your cs colleague and told him about this. Is it your colleague never feedback to the claims department? Or the claims department ignore what he tell them?
Cs: i understand sir. I will check with the claims department and get back to you.
Anyone of you here experience this before?
The claims department just can't be bothered and blindly process the claim?
For panel of gp clinics, it is as charged and cashless. For visits to specialist, 1 year can claim maximum $500. He has used finish the $500 specialist claim.
So he went to visit the panel of gp clinic on the 4th May. This claim is approved.
The clinic doesn't have the medicine. So the doctor write a prescription for him to buy it. He took the prescription to sgh pharmacy to buy it.
When submitting the claim, he attach doctor's prescription and invoice from sgh. He submit under panel of gp clinic. In the remarks, he write very clearly this is a follow up from 4th May claim to panel of gp clinic and tell them to see the doctor prescription which is attached.
To his suprise, the claims dept change the claim to be under specialist visit and rejected it. Remarks write claim is rejected as specialist limit of $500 has been used up.
Last week he call the cs. Explain to them this should be under panel of gp clinic claims and not under specialist claim. Also told them he has clearly attached the doctor's prescription from the panel of gp clinic.
Cs tell him they will feedback to the claims department on this.
Today he call the cs again to check on this claim.
Cs: the claims department has gotton back. It is rejected as your specialist claim amount of $500 has been used up as you bought the medicine at sgh pharmacy.
He: last week i told your cs colleague that this claim is under the panel of gp clinic. The clinic don't have the medicine so the doctor write a prescription for me. I bought the medicine at sgh pharmacy.
Cs: i understand sir. The claim invoice is from sgh.
He: so are you saying that in the future, when the panel of gp clinic write a prescription for me and i buy the medicine at sgh. Than it will be classified as claiming from specialist?
(Obviously this doesn't make sense)
Cs: ok i will feedback to the claims dept on this
He: last week i call your cs colleague and told him about this. Is it your colleague never feedback to the claims department? Or the claims department ignore what he tell them?
Cs: i understand sir. I will check with the claims department and get back to you.
Anyone of you here experience this before?
The claims department just can't be bothered and blindly process the claim?
