I Thought My Mum’s Insurance Could Cover Her $80,000 Operation. I Was Wrong.

I think of myself as someone who is generally up to date with their insurance; I set up automated payments for my premiums and meet up with my financial advisor regularly to discuss any changes to my current plans. 

I am also in charge of making sure my family is covered, including my mother. She didn’t have any insurance at all and couldn’t afford one, so I helped her get the basics: an accident plan and a hospitalisation plan. Her premiums were higher because of her age and pre-existing conditions, but I was okay paying for them as long as she was fully covered. 

Fast forward to this year. My mother required a critical operation. After being in and out of government hospitals, I decided to explore private healthcare as I thought the wait would be faster and the service better.   

I checked the terms of my mother’s insurance plan and was ecstatic that it covered private hospitals. I brought her down for a consultation the very next morning. 

The consultation was quick; the doctors said she could be scheduled for surgery that very night. All in all, the surgery and ward stay would cost $80,000. With her plan, I would only have to pay 10%, or $8,000, a sum I could afford. I provided her insurance details to the staff and waited to sign the papers. 

However, the hospital staff came back to me, saying her insurance couldn’t be used there. I was dumbfounded as I recall reading through the terms and seeing that it covered private hospitals. I questioned them, thinking that they made a mistake. 

They clarified that her insurance covered “private wards in government hospitals”, not “private hospitals”. I felt numb as they explained that I would have to pay the full $80,000, money that I did not have. 

In the end, I had no choice but to cancel the private hospital surgery and go to the government hospital. Due to overcapacity, she was admitted only after two days, but at least she was receiving the care she needed. 

I realised from that experience that I should not only be reading the terms and conditions of any insurance plans carefully, but it was important to clarify with my financial advisor or with the insurance company itself if I was unsure about anything. 

This article is part of TSS Confessions, a weekly column where we delve into personal finance topics that are unscripted and genuine real accounts from people.