‘Bait-and-switch’ tactics of insurance companies

Not too long ago I finally qualified to receive medical insurance from MedGulf. It’s Class “A”, which was supposed to give me pretty much all that I need with low deductibles and hard-to-get benefits like dental and vision.
After I was in the insurance company’s system for a few months I finally had a chance to use my insurance for routine tests and treatment at the International Medical Center in Jeddah. During my appointment, my physician filled out my pertinent medical data that ultimately include treatment and prescriptions.
I trotted down to the insurance office with my forms in my hand and submitted them for approval. An hour later I was rejected for coverage for treatment and the prescriptions. The procedure alone costs SR 3,000 and the prescriptions amount to about SR 1,000
The Cadillac of insurance companies, MedGulf here in Saudi Arabia, has found a clever way to hang on to patients’ insurance premiums and manage not to provide any services.
It appears the bottom line is that patients with pre-existing conditions are not eligible for coverage. OK, I can live with that. But it’s how they determine what is a pre-existing condition and how they document it makes their stellar Class “A” coverage a joke.
When the physician asked me how long I had my condition, I replied I didn’t know. When she pressed me for an answer, I said maybe a couple of months, but couldn’t be sure. What I do know is that when the symptoms appeared, I quickly made an appointment to see the doctor. So in reality, it was probably a couple weeks or so.
It did not occur to me that the physician’s recording of when the symptoms appeared was set in stone and her questions were not geared so much as to diagnose and treat my ailment, but to provide details for insurance purposes. The answer I gave, although I wasn’t specific about the time the symptoms first appeared, disqualified me from coverage because my condition existed before I was covered.
Further, the policy coverage manual specifically says that pre-existing conditions are covered. I appealed their decision three times, and was rejected each occasion.
Ranting and raving about insurance coverage is as old as dirt. So I am not breaking any news here. And yes, I am boo-hooing in my non-alcoholic beer over my fate. But at the end of the day, insurance companies try to find ways to reject claims. In this case they used a doctor’s casual notes about vague symptoms.
They exploit your lack of knowledge of the system. When I spoke to a representative of the insurance company, he sympathized with my predicament, but said that he was “looking at the system” and it shows that I have a pre-existing condition. I never filled out an application, nor spoke to any individuals about the exact date the symptoms appeared. Yet the insurance company had made that determination without my knowledge.
When I was in England, I had a similar Class “A” insurance policy and there was never any question about whether a pre-existing condition was an issue. In fact, as a policyholder through a corporate account and not an individual account, most illnesses, treatments and prescriptions are covered regardless of whether or not the condition had already existed.
People who purchase their own insurance should be aware of “bait-and-switch” policies in which a company will lure into a policy with the promise of a Class “A” treatment and then pull the rug out from under you when the first application for approval of coverage is sought.
Here is MedGulf’s solution to my problem following numerous conversations with their representatives: Re-submit my application for approval after I renew my insurance in six months. But there is nothing to stop the company from examining previous files to find my so-called pre-existing condition. I don’t trust MedGulf to keep its promise. Meanwhile, I go untreated.
MedGulf simply does not want to perform the services it promised. Even a simple prescription that was initially approved is likely to be rejected because its cost reached over SR 1,000.
I highlight these problems because Saudis and expat workers throughout the kingdom have similar insurance coverage policies, but fight the same battles against companies like MedGulf that exercise arbitrary policies to keep coverage from patients for the sole purpose of minimizing their losses and maximizing their profits.

Email: [email protected]