Understanding Gathercare’s Crowd Sharing Guidelines: How Not to Get Your Medical Case Rejected”

 Sharing the burden of medical expenses 

Gathercare is not just a platform for affordable medical treatment but a community that operates on the principle of sharing the burden of medical expenses. We believe that everyone should have access to top quality healthcare, and that’s why we have developed a comprehensive and fully subsidized medical ecosystem. However , as with any medical cost-sharing program there are certain rules and guidelines that must be followed to ensure fairness and sustainability.  

Program guideline 5.3.40 excludes coverage for competitive events. 

Unfortunately in October 2022, one of our carers suffered a Motocross accident that resulted in a bill of RM25,000 for hospitalization and treatment of an anatomical fracture of the left humerus. Although the carer applied for sharing of medical expenses, Gathercare management with advice from the medical auditor E-mas had to reject the claim based on program guideline 5.3.40 which states that professional racing or competitive events are not eligible for sharing. 

Responsibility to members and community-based principles 

As a community-based platform, Gathercare  has a responsibility to all its members to ensure that the sharing system remains sustainable and fair. This is why Gathercare’decision to reject the carer’s claim was based on program guideline 5.3.40, which defines professional racing as one’s primary vocation and means of financial support. It includes activities such as automobile, motorcycle, watercraft, ski or rodeo races or competitions. The guideline is clear that medical expenses related to such events , including treatments of disability while racing or competing as a professional are not eligible for sharing. 

Preventing potential abuse of the system 

It is essential to understand that Gathercare’s rejection of the carer’s claim was not a wrongful rejection but was based on the program guideline. As a community, we must ensure that all claims are assessed fairly and consistently and that the program remains sustainable over time. Adhering to the program guideline also ensures that the community ‘s resources are used responsibly and efficiently. 

Covering a wide range of medical expenses with certain rules and guideline 

By limiting what types of medical expenses are eligible for sharing, Gathercare aims to prevent any potential abuse of the system. This approach helps maintain the trust of the community and enables Gathercare to operate in a sustainable and responsible manner. Furthermore, it is important to consider that non-eligible hospitalization medical expenses for sharing such as professional racing or competitive events, exist to ensure that the community’ funds are used appropriately and effectively. 

In conclusion, Gathercare is a community-based platform that provides affordable medical    treatment to everyone through a medical cost-sharing system. The program is designed to cover a wide range of medical expenses, but certain rules and guidelines must be followed. The rejection of the carer’s claim was based on program guideline 5.3.40 which ensures that the community’s resources are used responsibly and efficiently.  By adhering to the program guidelines, Gathercare can continue to provide sustainable and affordable medical cost-sharing solutions to those who need it most.