Recently, more and more people say that they have had cataract surgery because it is covered by insurance, but they did not receive any money.

Patients only believed the doctor's words and received more than 10 million won in surgery.

So there are people who are in debt because of the cost of surgery. First, reporter Kim Jung-woo heard the stories of the patients.

<Reporter Kim Jung-woo>

47-year-old A, who had been blind for several years, finally underwent cataract surgery two months ago.

He wanted to have surgery, so he made a decision after asking detailed questions from various hospitals and insurance companies.

[Family of cataract surgery patients: Because the eyes are important, I went around three places to find the hospital.

Because everyone said that this person had cataracts and needed surgery, and the insurance company said that if we had cataract surgery, 100% of the insurance money would be paid...


Then, a month later, the insurance company suddenly determined that it was not a cataract, and he informed me that he could not pay the insurance.

The reason was not properly explained.

[Family of cataract surgery patients: When I call, they only talk like parrots.

It's useless to keep talking to me like this, so if you're going to sue, file a lawsuit.]

I can't afford a lawsuit, and I'm worried about how I will pay the 13 million won for the operation.

[Family of cataract surgery patients: Should I just look for a loan...

Now with credit card debt.

I paid by card.]

Mr. B in his 50s, who had cataracts and shingles and had surgery.

After the operation, he was pressured by people from the insurance companies who came to him and showed him documents from the Financial Supervisory Service stating that he could be punished if he had committed insurance fraud.

[Mr. B / Cataract surgery patient: There are many people who do it illegally, so an investigation is necessary.

I was very scared.

I couldn't even sleep at night.

My heart is pounding like crazy, and if I answer wrongly, I feel like I'm going to some kind of prison.

Such pressure.]

More than 7,000 similar complaints came to the Presidential Transition Committee in 20 days, causing confusion.

(Video coverage: Jeong Seong-hwa, video editing: Il Nam)



The biggest reason that made the situation like this was that some hospitals believed in loss insurance and excessively recommended surgery to people.

However, insurance companies can find problematic hospitals and prevent them from doing so, but there are also pointed out that the situation is even more twisted as they put pressure on insurers who are easy to touch.

We will continue the story after watching the coverage of reporter Im Tae-woo.

<Reporter Im Tae-woo> The sharp

increase in cataract surgery is largely to blame for some hospitals blinded to making money.

When each patient earns several million won, he mobilizes a broker to collect patients.

[Broker: When I introduce a customer to the Klitschko Hospital, I record it and give him 1 million won in cash.

800,000 won when the designer can't take the patient (to the hospital).]

Hospitals are also encouraging patients to return some of the surgery costs right away.

[Hospital official: If you pay the full amount by card, you close the card for 6,347,800 won, right?

2,347,800 won minus 4 million won, I'll return this to you right away.

To the patient's account.]

Insurance companies claim that insurance fraud is suspected, saying that about 60% of cataract surgery claims are concentrated in just 50 eye clinics.

But insurers have chosen to strengthen patient screening rather than fighting the problem hospitals directly.

We request a pre-surgical test result that is not in the terms and conditions and make a decision not to pay after going through a review by consulting doctors.

As the loss of indemnity insurance is so severe, the financial authorities seem to be taking the side of insurance companies this time.

In the meantime, insurance companies who faced over-examination against over-treatment at some hospitals, and ordinary subscribers who trusted the doctors in the meantime.

[Hwang Hong-seok / President of the Korean Ophthalmology Association: Just as one should not make one person unfair when catching a thief, an unfair victim should not appear here.

There is a fraudulent problem with insurance that provides money to patients and cannot take issue with the operation itself.]

(Video coverage: Park Jin-ho, video editing: Lee Seung-hee)



Reporter Im Tae-woo, who covered this content, is here.

Q. Insurance companies that do not pay patients, what is the rationale?

[Reporter Im Tae-woo: Insurance companies will decide whether to pay insurance by looking at the test strips they received at the hospital before surgery.

However, the Society of Ophthalmologists, a group of ophthalmologists, is against the introduction of this test strip.

This test strip is just a single photo of the inside of the eye, but they are against it, arguing how can you judge by looking at the photo without even looking at the patient's condition.

The Ophthalmology Society has been working on a common front with insurance companies saying that insurance fraud hospitals should be caught because all doctors are harmed, but opinions are divided about the introduction of this test strip.

There were even concerns that some insurance companies were abusing this test strip.]

Q. Abuse of the test strip, what does it mean?

[Reporter Im Tae-woo: I said earlier that insurance companies ask for the opinions of consulting doctors as well.

These advisory doctors are of the opinion that it is difficult to determine whether surgery was necessary just by looking at the photos for the same reason as I just mentioned. Something is happening.]

Q. What is the insurance company's explanation?

[Reporter Im Tae-woo: The insurance industry claims that if there are any other tests such as vision in the past, they are comprehensively judging them, and they are intensively investigating hospital patients suspected of insurance fraud.

However, it is questionable whether this is really the case as ophthalmology patients across the country are experiencing similar things.]

Q. What is the solution?

[Reporter Im Tae-woo: First of all, we need to change our thinking in the insurance industry.

Insurance companies already know where the insurance fraud hospitals are by providing statistics.

Then you have to fight the hospitals in question rather than the subscribers.

You have to file a lawsuit or file an accusation, but this takes a long time and is complicated, so if you do not pay insurance money to general subscribers, you have to file a lawsuit, but this is somewhat inappropriate.

The Financial Supervisory Service should also work closely with the police, the National Tax Service and the Ministry of Welfare to think more about how to catch insurance fraud hospitals.

The financial authorities should take care of the insurance companies that are in the red, but we also need to listen to the complaints of subscribers who are struggling with the sudden burden of surgery costs.]

(Video Edit: Park Chun-bae)