Very important to get right shield plan
‘AIA Healthshield Gold B paid $128 of $5,969 bill’
Oct 10, 2009, The Straits Times
Ms Cheam Teo Seng: 'I am insured under an AIA HealthShield insurance plan. I was warded for one day in Gleneagles Hospital for ankle surgery. The hospital bill totalled $5,969.13. Gleneagles submitted my claim for reimbursement to AIA, but the amount reimbursed was $128.61. AIA took three months to reply to my request for the discrepancy after I sent a complaint to its chief executive. The coverage provided by AIA has four categories, namely room and board, in‐hospital expenses, surgery and implants and approved medical supplies, with limits on the reimbursed amounts in each category. Gleneagles prepared its bill under nine categories. Some items in the prescriptions category were injections used in the operating theatre. According to my family doctor, these items should be classified as approved medical supplies. When Gleneagles submitted its bill to AIA, it classified the prescriptions category as in‐hospital expenses. These items were excluded from the claim reimbursement, as the amount exceeded the limit in this category. If they had been classified as approved medical supplies, they would have been reimbursable. Is mine an isolated case, or are many HealthShield policyholders paid less than what they are entitled to because of processing discrepancies?'
Reply from AIA: 'Meant to cover government hospitals"
Oct 24, 2009, The Straits Times
Ms Carolyn Cheong, head of claims, AIA Singapore: 'I refer to the letter, 'Medical insurance' (Oct 10), by Ms Cheam Teo Seng who is insured under AIA HealthShield Gold Plan B which is meant to cover hospitalisation in Class B/C wards in government hospitals. As Ms Cheam had her surgery done in Gleneagles Hospital, a private hospital, the medical expenses incurred far exceeded the claimable limits. As with all 'Shield' plans, there is a deductible and a co‐insurance portion. Ms Cheam mentioned that certain prescription items should have been classified under approved medical consumables instead of daily room and board. For Medisave approved 'Shield' plans, the claims are submitted by the hospitals directly. They would classify the various expenses and charges before submitting them through a centralised processing system. In Ms Cheam's case, Gleneagles had classified and submitted the items under prescriptions. Under Ms Cheam's insurance plan, the daily room and board benefit includes costs for prescriptions in addition to meals, professional charges, investigations and miscellaneous medical charges. Hence, prescriptions were considered under the daily room and board benefit for the purpose of her claims payment.
‘MediShield paid $1,438 of $50,000 hospital bill’
Nov 28, 2006, The Straits Times
Ms Chew Kai Hwa: 'ALL citizens who have contributed to Medisave qualify for health insurance, in the form of MediShield. This is so that, with rising health‐care costs, they have insurance to fall back on when they are taken ill. However, what happened to my mother‐in‐law recently proved unsettling. My mother‐in‐law was admitted to Gleneagles Hospital following a heart attack and the specialist there recommended that she undergo a bypass immediately. Unfortunately, she died without regaining consciousness. Now we are laden with medical bills of more than $50,000. As my mother‐in‐law was covered under MediShield, we expected at least a small portion of the bills to be taken care of by the insurance. However, after a long wait, the Central Provident Fund Board has granted us a payout of only $1,438, less than 3 per cent of the total bill. How is the payout determined? By subscribing to MediShield, we expect that it would help us to cover some of our medical costs but it is not of much help when the payout is so little. I hope the authorities will look into this issue. We are not asking for welfare ‐ just a reasonable payout from MediShield.
Reply from MOH: 'Why MediShield paid only $1,438 of huge bill'
MOH: In "MediShield paid $1,438 of $50,000 hospital bill" (ST, 28 Nov), Ms Chew Kai Hwa asked why MediShield could not pay a larger portion of her mother‐in‐law's hospital bill at Gleneagles Hospital. MediShield Basic is meant to help members pay for their hospital bills incurred at subsidised Class B2/C wards. As Ms Chew's mother‐in‐law was covered under MediShield Basic plan only, it would not fully cover the hospitalisation bill for her stay at a private hospital. For those who want additional protection to cover stays in private wards or hospitals, there are rider products that can be purchased to complement the MediShield Basic plan. These enhanced Medisave‐approved insurance plans are offered by 5 private insurers and a listing of such plans is available on the MOH website at www.moh.gov.sg. As there are many medical insurance plans, it is important, when choosing the type of plans to buy, to take into account the choice of hospital wards, the type of coverage desired and the affordability of premiums. Thank you.