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Health Insurance Claim Rejected for Pre-existing Condition
Insurance Claims Officer (speaking English) and Client (speaking Sinhala) talk through “Health Insurance Claim Rejected for Pre-existing Condition”. You interpret both ways — English into Sinhala, and Sinhala into English — one segment at a time, exactly as in the CCL test.
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Full transcript
Thanks for calling nib member services. I've been checking your claim for the knee arthroscopy at Liverpool Hospital, and there's something about your policy start date I need to clarify.
මොකක්ද ප්රශ්නය? මට අවුරුදු කීපයක් තිස්සේ දණහිසේ වේදනාවක් තිබුණා, ඒත් මම මේ රක්ෂණය ගත්තේ මාස අටකට කලින්.
Your policy has a twelve-month waiting period for pre-existing conditions. Since you joined only eight months ago, and the knee issue existed beforehand, the claim can't be approved yet.
එහෙනම් මට කරන්න පුළුවන් දේ මොකක්ද? මගේ සැත්කම ලබන සතියේ නියම වෙලා තියෙනවා.
You can lodge an appeal with a letter from your surgeon confirming the condition wasn't diagnosed before you joined. Our chief medical officer will review it.
ඒකට කොච්චර කාලයක් යනවද? මගේ සැත්කම දින හතකින් තියෙන්නේ.
Normally the review takes up to fifteen business days, but if your surgeon marks it urgent, we can expedite it within forty-eight hours.
අනුමත නොවුනොත් මට කීයක් ගෙවන්න වෙයිද?
Without cover, Liverpool Hospital quoted around eighteen thousand five hundred dollars for the procedure, though some public hospitals offer it at no cost with a longer wait.
මගේ පොලිසියේ අමතර ගාස්තුව අඩු කරන්න පුළුවන්ද, දුෂ්කරතාවයක් නිසා?
The five-hundred-dollar excess stays fixed unless the fund's hardship team approves a waiver. If you disagree with the outcome, you can contact the Private Health Insurance Ombudsman.
හොඳයි, මම දැන් සැත්කම ගැන සැලකිලිමත් වෙන්නම්, ලියුම ලබාගෙන ඉක්මනින් එවන්නම්.
Terms in this dialogue that cost marks
CCL is marked on information transferred. These Australian terms have no direct word in most test languages — get one wrong and the segment's information is gone.
- waiting period"waiting period" එලෙසම කියන්න; හෝ "ගෙවීම් ලැබීමට පෙර රැඳී සිටින කාලය" ලෙස පැහැදිලි කරන්න.
- excess"excess" යන වචනයම එලෙසම භාවිතා කරන්න; අවශ්ය නම් "ස්වයං දායක මුදල" ලෙස පැහැදිලි කරන්න.
- private health insurance"පෞද්ගලික සෞඛ්ය රක්ෂණය" ලෙස කියන්න; අවශ්ය නම් "private health insurance" ලෙසද එකතු කළ හැක.
- ombudsman"ombudsman" යන වචනයම භාවිතා කර, අවශ්ය නම් "ස්වාධීන පැමිණිලි විමර්ශන නිලධාරියා" ලෙස කෙටියෙන් පැහැදිලි කරන්න.
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Practice dialogue written to the CCL specification (two speakers, segments of 35 words or fewer, about 300 words). It is a practice text, not a NAATI test paper, and the AI score is this site's estimate, not a NAATI result. All Sinhala dialogues · All languages