I think the threads outlined so far on the above topic just show how confused customers are with Laya when making a claim for everyday medical expenses.
The reality is that there is a conflict between what Laya are stating on their website and also their outpatient claim form regarding how far back you can go to claim medical expenses, to what the Laya app states and also what Laya have confirmed to me on several occasions when challenged.
Their website states - Claims must be submitted within 12 months of the treatment date on your receipt.
Their outpatient claim form also states " Claims must be submitted within 12 months of the treatment date on your receipt.
However the Laya app states- Members can claim on receipts once they are submitted within 12 months of your renewal date. If receipts aren't submitted within this timeframe, your claim will not be paid.
So, there is a big difference between the two definitions, yet Laya are referring to the exact same subject. Even the Laya app is not totally clear how far back you can claim but it is closer to the reality. Two separate staff members confirmed to me when challenged that there is clearly a difference in meaning as outlined in their website as compared to their app. When I asked one staff member is their website inaccurate-they replied yes and they will get this changed. When I checked their website today, it is still giving the same terminology as quoted above.
The rule as confirmed to me by Laya after challenging them on their original misinformation is as follows;
THE RULE CONFIRMED TO ME IS THAT YOU GO BACK TO THE LAST RENEWAL DATE ON YOUR POLICY- YOU THEN GO BACK 12 MONTHS FROM THAT LAST RENEWAL DATE AND THAT GIVES THE MEMBER THE EARLIEST DATE HE/SHE CAN CLAIM HIS MEDICAL EXPENSES.
Lets look at examples to understand this better.
Example 1- Lets say the member has the normal calender year as his policy term. So we are now in 6th Nov 2021. His last renewal date was 1st Jan 2021, so he can go back 12 months to 1st Jan 2020 to claim his everyday medical expenses.
So you can see even from this example, that he could have a doctors bill on the 2nd Jan 2020, which he can still claim today, even though the doctor receipt is way beyond 12 months (which conflicts with Laya's website definition). So in this case, once he submits all his bills for 2020, he can claim these before 31st Dec 2021.
Example 2 - The same member as example 1, but this time he wants to claim for a doctors bill dated 29th Dec 2019.
You apply the same process as example 1, but as the furthest you can go back is the 1st Jan 2020, then it falls out by
just two days so no claim can be made.
Example 3 - Lets say the member has a member has the renewal date of 1st October as his policy term start date. So we are now in 6th Nov 2021. His last renewal date was 1st Oct 2021, so he can go back 12 months to 1st Oct 2020 to claim his everyday medical expenses.
The key point to remember is that if your renewal date was only a few weeks ago, like in this example then you only go back 12 months from the last renewal date.
I hope the above explains the correct way to claim Laya medical everyday exps.
I think its incredible that their staff and also their website are giving out the incorrect information when claiming expenses. As can be seen from the examples outlined, there can in many cases be well over 12 months from the date of the receipt that a member can still be entitled to claim their expenses. This is clearly at odds with the website definition as outlined above.
I think its also incredible that their website is incorrect on this topic and even when I pointed out this error this still hasn't changed.
I wonder how much medical expenses should have been reimbursed to customers and through misinformation have not been claimed and now possibly cant be claimed?