For almost a quarter of a century, my employer in Japan paid for a health insurance policy. It was comprehensive, required of me regular health check-ups, and year by year became more expensive, despite the fact that I never made a claim.
On the rare occasion that I needed to visit a doctor or buy medication, I chose to pay for it, in the knowledge that in the Japanese system, medical expenses in excess of a certain amount can be offset against taxes.
My reasoning was simple: making a claim for a relatively simple procedure would simply have an adverse effect on the weighting of the next year’s premium.
Meanwhile, having the policy in place was a reassurance in case something more serious came along.
Something did. I have written in a previous column about the sudden need for extensive cardiac surgery and the repercussions of the operation.
When I knew I needed to undergo such procedures, I contacted my insurance company (a well-known, UK-based firm with a global reach) and their immediate response was to reassure me but also to ask for the contact details of my regular physician so that they could check my medical records. No problem.
Two surgeries, thrice-daily blood tests, countless X-rays, innumerable ultra-sounds, MRIs and CT-scans later, my two-and-a-half week hospital stay came to an end with a bill of some 10 million yen.
To my great surprise and distress, however, the insurance firm declined to pay, citing a clause in the agreement about “pre-existing conditions”.
All very well, but according to the same agreement such a condition was defined as one which had existed within a two year period prior to the commencement of the policy.
According to this definition, my cardiac disease must therefore have been present as far back as the mid 1980s, yet successive annual medicals had found no trace of it and indeed, as recently as 2008, as a nod to my age, I’d undergone a detailed examination in a Tokyo cardiac center.
All of this information was made available to the insurance firm, which nevertheless continued to insist that I was in default of the terms of our agreement, the small print of which was voluminous.
I was to discover from friends in the industry that this is not an uncommon situation in cases in which a substantial claim is under debate. The insurer hopes that the insured will simply give up under the pressure of increasingly bureaucratic and somewhat threatening language.
I was not about to capitulate; apart from the money itself, there was a principle at stake.
I was fortunate in having gracious lawyers and friends in the insurance industry itself, but I couldn’t help thinking about how I would have felt if I had been elderly and alone without such sources of support.
In addition, as a trained and qualified arbitrator, I had knowledge of the Law of Contract and made sure the insurance company knew that I did, and that I would use it. The minute I flagged this up to them, they agreed to settle immediately, though they did not admit liability.
In the interim, the hospital had been most sympathetic. The administrator suggested that I apply at once for Japanese national health insurance.
I protested that it was a little too late but I was assured that since I would need to backdate my payments by one or two years, I would indeed be covered retrospectively. The amount I would need to pay in was considerably less than the hospital bill.
This advice was sincerely motivated and I am grateful for it. The insurance firm settled the bill in total.
My regular visits to the outpatient department and the substantial amount of medication I must now take are significantly more affordable as a result of national health coverage and, in hindsight, I wish I had signed up sooner.© Japan Today