Case study
New Policy: Cashless Claim Approval for 7cm Gallstone Surgery
By Woode Woo, Agency Manager
👤 Client profile
• Age: 58 years old, female
• Policy Commencement Less than 1 year
• Policy Commencement Less than 1 year
📉 The Challenge
• The client was diagnosed with a 7cm gallstone that required immediate hospitalisation.
• Because the policy was less than a year old, the insurance company suspected it was a pre-existing condition.
• Their reasoning: a gallstone of that size typically takes years to form, and therefore could not have developed within a few months of purchasing the policy.
• This meant the client risked losing her coverage benefit and having to pay the full bill herself.
• Because the policy was less than a year old, the insurance company suspected it was a pre-existing condition.
• Their reasoning: a gallstone of that size typically takes years to form, and therefore could not have developed within a few months of purchasing the policy.
• This meant the client risked losing her coverage benefit and having to pay the full bill herself.
💡 The Solution
Our team investigated the client’s medical history and discovered an important detail:
• Shortly before the policy started, the client had undergone a scan due to a kidney issue claim.
• That scan clearly showed no gallstones present.
• We submitted this medical evidence directly to the insurance company, proving that the gallstone developed after the policy commencement.
• Shortly before the policy started, the client had undergone a scan due to a kidney issue claim.
• That scan clearly showed no gallstones present.
• We submitted this medical evidence directly to the insurance company, proving that the gallstone developed after the policy commencement.
🎯 Key Benefits of the Change
• Medical records matter: Prior scans and reports can be decisive in disputed claims.
• Expert advocacy saves time and stress: FINNO’s claims team knew exactly what proof was required.
• Peace of mind for clients: Even in complex situations, our clients can count on FINNO to defend their rights.
• Expert advocacy saves time and stress: FINNO’s claims team knew exactly what proof was required.
• Peace of mind for clients: Even in complex situations, our clients can count on FINNO to defend their rights.
✅ Outcome
• The insurer accepted our evidence.
• The client was able to enjoy cashless admission, without having to pay hospital bills upfront.
• Coverage for the gallstone surgery was fully approved.
• The client was able to enjoy cashless admission, without having to pay hospital bills upfront.
• Coverage for the gallstone surgery was fully approved.