Previously, we shared a case where a mere three-word error in a medical record resulted in the denial of a 300,000 RMB insurance claim.
Recently, another policyholder encountered a similar situation. Fortunately, with the guidance of our claims experts, the medical record was corrected, and the claim was successfully paid out. Today, we will delve into this case in detail. Below is the claims summary: Now, let’s examine the full claims process step by step. 1. A Single Typo in the Medical Record Nearly Cost a 500,000 RMB Payout In June, Ms. Q purchased a 500,000 RMB iWorry-Free 2.0 critical illness insurance policy with the assistance of our planner. In September, Ms. Q noticed a suspected lump in her right breast and underwent a detailed examination. The results indicated a Grade 4 nodule, and the doctor recommended further treatment. Upon receiving this news, Ms. Q immediately contacted our planner, who expressed concern and, during further communication, discovered an error in the medical record: “right breast cancer external mass for half a month” instead of the correct “right breast external upper mass.” The planner consulted our internal claims experts, who preliminarily concluded that the doctor had mistakenly written “cancer” instead of “gland.” The experts warned that this typo could jeopardize the claim and advised Ms. Q to correct the error with the doctor, providing guidance on the amendment process. After communicating with the doctor, Ms. Q successfully corrected the typo in the medical record. A month later, following the doctor’s recommendation, Ms. Q underwent surgery. The pathological results confirmed a diagnosis of (right breast mass) invasive breast cancer. Subsequently, Ms. Q contacted the planner to consult the claims experts about the detailed claims process. On October 25, with the experts’ assistance, Ms. Q formally submitted her claim to the insurer. The insurer requested an in-person interview, which was smoothly completed after our planner briefed Ms. Q on the necessary preparations. Within a month of submission, the insurer approved the claim, determining that Ms. Q’s condition met the policy’s critical illness criteria, and paid out the 500,000 RMB benefit. After receiving the payout, Ms. Q reflected, “While it’s unfortunate to have cancer, I’m grateful for having insurance. Without it, my life would be in chaos, and I wouldn’t be able to focus on treatment with peace of mind.”At the same time, she expressed deep gratitude to our planner, noting that all staff members were highly dedicated and professional, from recommending the right insurance product to the successful processing of her claim.
In appreciation, Ms. Q presented our planner with a commemorative banner. 2. What lessons can be learned from this claims case? Many people visit hospitals but rarely pay attention to how doctors document their medical records or whether errors are present. Medical records significantly impact us, especially for those with insurance. Mistakes could lead to denied claims. Therefore, during medical visits, it’s crucial to keep the following points in mind: 1. Avoid exaggerating symptoms to emphasize severity. For example, do not speculate about undiagnosed conditions by saying, “I think it might be this disease,” “I may have had this before,” or “I might have had it years ago.” Such vague statements may mislead doctors into documenting them as “pre-existing conditions,” which insurers could interpret as non-disclosure or pre-existing ailments, resulting in claim denials. 2. Inform the doctor about your commercial insurance coverage. Politely request the doctor to document your records carefully, avoiding typos or ambiguous language. If the injury is accidental, ensure the doctor clearly states it was caused by an accident to prevent claim complications. 3. After the visit, review the electronic medical records thoroughly. Verify personal details for accuracy and ensure the documented content aligns with your actual statements during the visit, particularly regarding pre-existing conditions. What if you discover errors in your medical records? Promptly consult the doctor to correct the records. For minor errors like incorrect names, ask the doctor to reissue the records. For typos or incorrect dates, avoid haphazard corrections. Follow the “Basic Standards for Medical Record Documentation” by retaining the original text, having the doctor amend it with a timestamp, and affixing the hospital’s official seal. If outdated records contain uncorrectable errors, preserve past and current health examination reports as evidence of your condition. Additionally, our professional claims team offers end-to-end support. If you’ve purchased insurance through us and encounter an incident, contact us immediately. Our claims specialists will guide you through the process to ensure a smooth resolution.At this point, there’s no need to worry excessively. Minor errors in medical records do not necessarily lead to immediate claim denials by insurance companies. After a thorough investigation, legitimate claims will still be processed as usual, albeit with some additional time required.
Therefore, we’d like to remind everyone once again to pay extra attention to the accuracy of medical records during consultations. Lastly, we sincerely wish everyone good health and safety, hoping you’ll never need to use insurance.
