Mr. Kwan was admitted to a hospital in China for 14 days due to severe stomach pain. He was diagnosed as having gastritis. No operation was performed and Mr. Kwan was treated with medication only during his hospitalisation.

After being discharged from hospital, Mr. Kwan submitted his claim for hospital cash benefit and hospital expenses to his medical insurance company. However, his medical insurance company settled only the first 3 days of hospital cash benefits and corresponding medical expenses for his hospital confinement, but refused to pay for the remaining 11 days hospital cash benefits and medical expenses incurred.

Why did Mr. Kwan's medical insurance company reject part of his claim?

When the insurance company enquired about Mr. Kwan's medical record, it was found that Mr. Kwan's stomach pain was alleviated considerably by the 3rd day and his attending doctor only continued to give Mr. Kwan gastric medicine for the rest of his hospitalisation. The insurance company also discovered that Mr. Kwan had taken home leave from 1pm to 8 pm daily starting from the 4th day onwards.

Therefore, Mr. Kwan's medical insurance company rejected Mr. Kwan's claim for hospital cash benefit and medical expenses incurred from the 4th day to the 14th day on the grounds that the corresponding period of hospital confinement was medically unnecessary.

As discussed in previous medical insurance tips articles, medical insurance only provides cover for medically necessary hospital confinement. Insurance companies will pay for a reasonable length of hospital stay and corresponding expenses depending on the medical condition and treatment of the patient.

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