11/05/2026
Alhamdulillah... 1 lg claim client APPROVED!
Sebenarnya saya sangat takut claim ni decline tapi alhamdulillah.. claim ni bukan salah client dan bukan juga salah hospital, cuma keadaan tu la yang entah mcm mana mau cakap 😂😂
Kronologi:
17 Apr - client text tanya kes denggi Aia cover? Without hesitation saya reply yes cover.. boleh treated as outpatient juga tu, tp kena p hospital. Sebab aia memang ada cover outpatient treatment for bronchitis, pneumonia, influenza, and also dengue, ini mmg stated dlm PDS ni..
- so client bgtau sdh p clinic dan confirmed positive denggi, kena bg letter p queen, tapi lama tunggu so client ubah fikiran mau p private.
- time ni client sdh demam more than 1 week, with flu and nose bleed..
- so client went to K**, unfortunately, bila dpt result darah, aihhh, it's negetive..
- as agent.. mataila, client kena bayar juga tu lab test 😅
- so client bayar dan saya submitla claim dia together with the letter from clinic to Queen and the test result.. saya memang berabis sdh fikir confirm kena appeal ni..
Tapi kan.. alhamdulillah today on 11 May, claim approved.. balik2 baca tu letter dr Aia, the client’s claim is approved for payment, but under a special exception.
The key points are:
1) Normally, the claim would be not payable because the treatment was done as an outpatient without hospital admission.(And actually blood test result show negetive ba tu, that's why la...)
2) However, the company decided to approve and pay RM589.35 as a goodwill / exceptional payment.
They are also saying this approval is:
based on special circumstances,
not a guarantee for future similar claims,
and not changing the original policy terms.
The important sentence is:
“the Company has agreed to pay the claim of RM589.35 on an exceptional basis”
Argghhh thank u Aia, bukan client jak lega aku agent dia pun lega...
Nampak sikit jak tapi still itu duit client..
So, Aia memang bagus gaisss, dia bayar juga claim client ni walaupun negetive test result tapi utk kes ni jak la bukan salah client sbb memang client ni ada denggi cuma time buat test tu, sudah jadi non reactive.. so bukan salah hospital juga dan GL mmg tidak kena request time tu sbb bukan denggi...
So sekian cerita saya hari ni, super excited dan sangat bersyukur claim approved..