In 2018, the client learned about Pacific Prime and reached out to us for medical insurance coverage. After understanding the client's actual protection needs, budget, medical habits, and range of activities, the insurance advisor concluded that the plan did not need to cover expensive hospitals, and that a focus only on hospitalization benefits would be sufficient. Based on this assessment, the advisor recommended several plans that covered only hospitalization, effectively managing potential financial impacts from major medical risks while keeping premiums at a reasonable level.

At the time of application, the client had some pre-existing health conditions. The advisor carefully assisted in preparing complete documentation and communicating with the insurance company. Following professional medical underwriting, the insurance company excluded certain incurable diseases with a high chance of recurrence, and the client successfully secured coverage.

 

In March 2024, the client noticed a swelling in the jaw and went to the hospital for examination. An ultrasound suggested further confirmation via CT scan. During this time, the client also consulted ENT specialists, who discovered another tumor in the nasal cavity upon detailed examination. Following endoscopy, CT, and MRI scans, the physician recommended prompt surgical removal of the tumor.

The client underwent the first surgery in early April, successfully removing the tumor and sending it for pathological examination. Two weeks after the surgery, pathological sections revealed that the excised tissue was a malignant melanoma with lymph node metastasis. In late April, the client had additional growth in the jaw and underwent a second surgery to clean lymph nodes and remove the new tumor.

After the surgery, the patient followed medical advice and attended follow-up appointments. Immunotherapy was used for a year, and the patient is currently in a stable condition.

 

Faced with a sudden severe illness, the client needed not only professional medical services but also efficient insurance services and claims support. After learning about the client’s condition, our service team responded quickly, assisting the client with related matters effectively. Leveraging familiarity with the insurance company’s processes and a long-standing good relationship, the service team provided the client with professional pre-authorization and claims assistance:

● Professional Guidance: The service team communicated efficiently and closely with the client, explaining the pre-authorization application process and necessary documentation for claims, ensuring completeness and compliance.

● Efficient Pre-Authorization: The pre-authorization application was approved by the insurance company within two working days, allowing the client to receive treatment with peace of mind.

● Fast Claims: The claims application along with the compensation was completed within ten working days, significantly alleviating the client's financial pressure.

Although the client's policy did not include general outpatient benefits, cancer treatment is classified as special outpatient care, allowing for the reimbursement of related outpatient and subsequent surgery and hospitalization costs in this claims case. To date, treatment costs have surpassed RMB ¥700,000, which has been fully compensated by the insurance company.

 

Our company consistently upholds the service principle of "simplifying insurance," which is reflected not only in the interpretation of terms but also in meticulous client service. Pacific Prime has focused on the insurance field for many years, specializing in personal and family insurance, employee benefits, and corporate insurance. If you have any insurance needs, please feel free to contact us. You can click the image below for a quick consultation. Our insurance advisor will reach out to you at your convenience.