SHUK FAN asked in 商業及金融保險 · 9 years ago

旅遊保險醫療費用索償

我媽媽在五月到美國旅行時跌傷了右腿, 在當地醫院進行了髖關節更換手術, 我有替她買旅遊保險, 可是保險公司沒有將人工髖關節計算在陪償額內, 請問可否追討? 因為保單上沒有說明人工關節屬不保事項.

Update:

謝謝各位提點, 我媽媽接受的手術是 Hemiarthroplasty of the Hip because of fractured femur. This was suggested by the doctor. 請給我多一點意見, 謝謝!

Update 2:

The money i obtained is approximately half of the max coverage.

Update 3:

My mother injured right leg 3 days ago before going to hospital. The operation was performed in the second day after admission.

4 Answers

Rating
  • Chi
    Lv 5
    9 years ago
    Favorite Answer

    You will have to ask some professional if the insurance should be covering this cost or not.

    In general, pay more attention in these points:

    - Almost all insurance comes with a max coverage. If the money you obtained is close to the max coverage already. You can forget about it as you won't get too much more from the insurance anyway.

    - If the treatment was medicial necessarity? This part is hard to judge what is necessary. If it is a optional treatment, the insurance will not cover it in most cases.

    - Most insurance has some internal appeal process. If you felt it was unfair, you should be able to write letter to list out your reasons and request for review.

  • Gary
    Lv 7
    9 years ago

    You can try. But without looking at the policy, I will say the insurance company will not move its position at all.

    The reasons are as follow:

    1. When your mother injured right leg, why replacing the hip joint? (Totally unrelated)

    2. Has the injury serious enough for warranting a surgery to replace hip joint? (In other word, there is no degeneration involved in this or her hip is not resulted from normal wear and tear).

    In most of the cases, hip joint replacement surgery is considered as a elective surgery as it will improve patient's quality of life without using walking aids or medication. So surgeons will not usually schedule these surgery unless necessary.

    And this is also why the insurance company don't want to cover.

  • 9 years ago

    你係透過旅行社買,還是透過 agent 買?因為一般旅行社賣的旅遊保險其賠償範圍係比保險公司賣的旅遊保險嚟得窄,所以相對保費會比保險公司平少少。

    你可以睇清楚你份保單,唔係單張,如果保單內沒有註明其醫療賠償範圍,你係可以去保險業聯會度查詢。

  • 9 years ago

    你好,

    可以 e-mail 解答你問題.

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