Why I had to pay RM8,500 despite having insurance

When Alyssa Lee purchased her medical insurance, she believed it would cover all her medical expenses, sparing her from any out-of-pocket costs. However, her experience revealed a different reality, demonstrating the complexities and limitations of insurance coverage.

"When I bought insurance, I thought it would be enough to cover all my medical expenses and I wouldn’t have to worry about medical bills anymore. I was wrong," Alyssa shared.

In April, Alyssa's knee, which had been problematic for years, finally gave way during an overseas trip. Upon returning to Malaysia, she was diagnosed with a meniscus tear and an anterior cruciate ligament (ACL) injury, necessitating surgery. The surgery cost RM38,000, which her insurance covered. However, this was just the beginning of her financial ordeal.

The Costly Road to Recovery

Post-surgery, Alyssa's doctor recommended physiotherapy twice a week to aid her recovery. Unfortunately, her insurance policy did not cover outpatient treatments. Each physiotherapy session cost RM127, and after four months, Alyssa had spent RM4,064 on these sessions alone.

Additionally, she needed follow-up consultations with her doctor, costing RM110 per session, totaling RM440 over two months. On one occasion, she had to pay RM220 for prescribed pain medication.

Alyssa also developed an allergic reaction to her knee brace, resulting in further medical expenses. "I was referred to a dermatologist who prescribed pills, and a medicated lotion and body wash. Consultation and medication there cost RM500," she recounted.

Additional Non-Medical Expenses

Beyond medical costs, Alyssa faced increased everyday living expenses. "After my surgery, I was on a lot of pain medication. This made me drowsy throughout the day, which made going grocery shopping or preparing food close to impossible for two months. Food delivery was my only option for all my meals, and I would spend about RM45 every day, just on meals alone," she explained.

Moreover, her stiff leg brace prevented her from driving, necessitating the use of e-hailing services for doctor’s appointments, costing RM12 per trip.

Lessons Learned

Reflecting on her experience, Alyssa realized the importance of thoroughly understanding her insurance policy. "Since I have medical insurance, I didn’t think twice about going to a private hospital because I thought all my expenses would be covered by my insurance," she admitted. Had she known her policy did not cover outpatient treatment, she would have opted for a government hospital, where costs are significantly lower.

Alyssa also recognized the importance of timely medical attention. "I also shouldn’t have delayed seeing the doctor for my knee. I could have saved myself all this trouble and maybe even avoided surgery if I had gotten it checked earlier," she noted.

Moving Forward

Alyssa plans to review her insurance policy with her agent to ensure it covers outpatient treatments and other potential expenses. "I will also make it a point to review my policy regularly as different milestones of my life require different coverage," she said.

Despite the unexpected expenses, Alyssa is grateful that her insurance covered the surgery. "This experience has opened my eyes to the importance of having insurance and has spurred me to look at other insurance coverages such as personal accident and critical illness insurance," she concluded.