Claim case sharing
Definition of Hospital Confinement
Mr. Chan broke his leg on a slippery floor and was admitted to Queen Mary Hospital (QMH). He was diagnosed with a fracture of the right femur and was operated on immediately. After staying in QMH for 14 days, he was transferred to MacLehose Medical Rehabilitation Centre (MMRC) on his doctor's referral for physiotherapy treatment for 50 days.
After being discharged from MMRC, Mr. Chan submitted his hospital cash benefit claim to his medical insurance company. However, his medical insurance company settled only the 14 days hospital cash benefits for his hospital confinement in QMH, but refused to pay the remaining 50 days hospital cash benefits for his stay in MMRC.
Why did Mr. Chan's medical insurance company reject his hospital cash benefit claim for his confinement in MMRC?
Despite the fact that Mr. Chan was referred to MMRC by his attending doctor, his insurance company decided that his confinement in MMRC did not satisfy the policy definition of Hospital, which contains specific reference stating that it does not include “establishments for convalescence and rehabilitation”. Therefore, Mr. Chan's confinement in the rehabilitation centre was not eligible under a claim for hospital cash benefit.
Some customers may not be aware of the difference between a hospital and a rehabilitation or convalescence centre. Although patients might have been referred by their doctors, confinement in these rehabilitation centres is not usually regarded as hospital confinement and is therefore not covered by medical insurance policies.