Complaint against Insurance agent?

Question

I was discharged from the hospital on January 2008. I was shocked when I was told that I need to pay RM612.00. On the very first day when I was admitted to the hospital, I had already presented my medical card to the hospital's admission office. I was shocked why this amount was not covered by the insurance and hence has to be borne by me? So I immediately called up my insurance agent to find out what's going on. She promised to call me back but she didn't. I even rang her several times but no answer. I had no choice but to call the insurance company directly and I was told by your customer service that there no referral report from previous doctor Dr. Rajban, one of the doctor treated me. Finally i wrote a complaint letter to the insurance company about the poor service of the insurance agent. After few day suddenly she went to my house with the letter to argues. I get shocked how she has the photocopy of the letters. May i have a sample letter of complaints for above matters?

Answer 1

If you have a plan that requires that you obtain a referral from your primary care physician before being seen by another doctor then the new doctor's staff should have not seen you with out this referral in hand.  Let your primary care know of this situation, they can remedy it for you. Don't complain about the agent, that is the last thing that you should have done, it is not her job to go around getting you referrals every time you go to the doctor. Shame on you, apologize to your agent and ask her to explain the specifics of your plan again.

Answer 2

I am not sure which country you are staying.

However in my homeland here in Singapore, insurance company and agents are operating under code of Ethics and govern by the MAS.

We also have a organisation setup to help solve dispute or complaints from consumers. So do find out if your country do have such govt bodies or organisation where you can bring up your case for assistance.

hope you are doing well now

Answer 3

If you are in the USA, try talking to your State Insurance board. They might be able to give some pointers or perhaps even resolve this matter if they see something wrong. Nobody likes having the State investigate them.

Answer 4

I agree with Tori, the Doctor failed to file the report so the claim was denied.  That is NOT the agents fault OR the insurance companies.

Have the doctor file and then the hospital resubmit the claim.  When all this is reported to the DOI, they will most likely favor the company because you failed to follow through.

The agent should have called you back though.  And just because she had not called you back or answered the phone, does not mean she wasn't tracking the answer down for you.

Answer 5

If I were you I'd spend some time on that Dr that didn't properly refer you out - instead of blaming the insurance agent for a Dr's mistake.

The Dr can correct that mistake and then have the hospital re-submit the claim for payment

This was simple advice & I agree you should've gotten this advice from YOUR insurance agent...but the complaint letter was kind of rude

You were told the problem was the Dr - and you took NO action towards him at all?...that was your mistake in my opinion - an agent shouldn't have to hold your hand thru these things unless you are UNable to do them yourself....which your phone calls & letter-writing proves is NOT true - you were able bodied enough to do that!