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There was a lot of controversy over the fact that some ophthalmology clinics had performed unnecessary cataract surgery on indemnity insurance policyholders.

Then, insurance companies made the insurance payment review difficult, which is another problem.



Reporter Jin Song-min reported. 



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Mr. Park, in his 50s, who lives in Gyeonggi-do, underwent cataract surgery at an ophthalmology clinic in Seoul last March.



The cost is 14 million won.



Park, who had signed up for indemnity insurance 13 years ago, submitted her related documents to the insurance company and waited for her to pay the insurance money.



[Mr. Park (51 years old) / Cataract surgery, loss insurance subscription: There was no contact until ten days passed.

He said, 'Why can't I send money?'

Then he said that he would go to another teacher for advice.]



After about a month, the insurance company notified the insurance company of refusal to pay, saying that it was difficult to see that the consultant needed surgery.



This is the opinion of an advisor who is a professor at the medical school.



She wrote about the need for surgery, "It's hard to make a one-size-fits-all decision."



The insurance company interpreted this as 'unnecessary surgical findings'.



I checked with my advisor.



[Consultant/Professor of ophthalmology, ○○ Medical School: (Mr. Park) Even the medical certificate says that you have cataracts of more than moderate severity.

Well, actually, there is no problem with cataract surgery.

However, the insurance company will give (insurance money) only if it is objectively proven by a photograph (slit lamp microscope) of



'severe severity' .

He did not decide that this is not the case, but literally asked himself, 'It is difficult to judge based on the submitted photos'.



[Consultation/Professor of ophthalmology, ○○ Medical School: (Slit lamp microscope) You must have a very good camera.

Suddenly (insurance company) asked me to prove it now, but in some ways, the camera may be bad.]



The insurance company told reporters, "It is not appropriate to reveal the position of individual companies as the cataract-related issue is a common issue in the insurance industry."



Last year, the loss ratio of the indemnity insurance was 132.5%.



In the process of the insurance industry responding to over-surgery in some ophthalmic hospitals and clinics, some insurance companies are creating another controversy of over-examination.



[Mr. Park / (51 years old) subscribers who have been denied insurance benefits: Insurance premiums go up once every 3 years.

I'm paying 98,000 won (per month) now.

I don't give what I deserve, and I think this is the tyranny of the insurance company.]



(Video coverage: Hyunsang Kim)