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Claim case sharing

Is hospitalisation mandatory for colonoscopy medical insurance claims?

Mr. Chan has a medical insurance policy. In view of his age, his doctor advised him to undergo a colonoscopy. The check-up was routine and simple, and as a result, Mr. Chan did not need to stay overnight at the hospital and returned home the same day.

He then filed a claim with his insurance company for the cost of the colonoscopy. When his insurance company rejected his claim, Mr. Chan guessed that the rejecting reason was because his colonoscopy did not involve hospitalisation.

Actually, most medical insurance policies cover day surgery, which means that hospitalisation was not a prerequisite for Mr. Chan’s claim case.

Yet, Mr. Chan was rejected because his colonoscopy was a preventive measure in this case. Despite the fact that it was recommended by his doctor, it was not based on Mr. Chan’s current medical need. To clarify, if Mr. Chan has been suffering from abdominal pain, and based on his doctor’s diagnosis, had undergone the colonoscopy to find out the cause of the pain, the cost of the colonoscopy would have been covered by his insurance policy whether he was hospitalised or not.

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