<TABLE border=0 cellSpacing=0 cellPadding=0 width="100%"><TBODY><TR>Processing discrepancies, not insured amount, were the issue
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<!-- START OF : div id="storytext"--><!-- more than 4 paragraphs -->I REFER to last Saturday's reply by AIA, 'Her insurance plan was...meant to cover government hospitals'.
AIA clarified that the amount reimbursed was only $128.61 because its HealthShield Plan B is meant to cover hospitalisation in Class B/C wards in government hospitals. This statement has misrepresented the Healthcare Financing Framework the Government has put in place to help Singaporeans pay their medical expenses. Government subsidies of 20 per cent to 80 per cent in Class B/C have kept health care affordable.
The table below shows the estimated bill size for all classes in Singapore General Hospital for the ankle surgery I had in Gleneagles at $5,969.13.
A1+ (Patient Class); $2,448 (Average Bill Size)
A1; $2,413
B1; $2,124
B2; $1,186
C; $924
If I had opted for hospitalisation in a Class B/C ward as advised, AIA would have had to reimburse zero, taking into consideration the deductible and co-insurance portion.
My issue is not the amount of reimbursement but the processing discrepancies. Due to the wrong classification of the cost of injections, $270.29 was not reimbursed to me. AIA explained that the claims are submitted by the hospitals directly through a centralised processing system. In a letter sent to me, AIA wrote: 'Your claim was accessed based on the submission by Gleneagles and paid in accordance with the benefits provided under the policy. Unless Gleneagles establishes that there is a change in the classification of the charges and re-submits the e-filed claim, we will not be able to pay a higher amount.'
Is the insurer, Ministry of Health or CPF Board responsible for auditing the rules hospitals use in the classification of hospital charges? Is the detailed claim settlement not retrievable from the central processing system?
Cheam Teo Seng (Ms)
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<!-- START OF : div id="storytext"--><!-- more than 4 paragraphs -->I REFER to last Saturday's reply by AIA, 'Her insurance plan was...meant to cover government hospitals'.
AIA clarified that the amount reimbursed was only $128.61 because its HealthShield Plan B is meant to cover hospitalisation in Class B/C wards in government hospitals. This statement has misrepresented the Healthcare Financing Framework the Government has put in place to help Singaporeans pay their medical expenses. Government subsidies of 20 per cent to 80 per cent in Class B/C have kept health care affordable.
The table below shows the estimated bill size for all classes in Singapore General Hospital for the ankle surgery I had in Gleneagles at $5,969.13.
A1+ (Patient Class); $2,448 (Average Bill Size)
A1; $2,413
B1; $2,124
B2; $1,186
C; $924
If I had opted for hospitalisation in a Class B/C ward as advised, AIA would have had to reimburse zero, taking into consideration the deductible and co-insurance portion.
My issue is not the amount of reimbursement but the processing discrepancies. Due to the wrong classification of the cost of injections, $270.29 was not reimbursed to me. AIA explained that the claims are submitted by the hospitals directly through a centralised processing system. In a letter sent to me, AIA wrote: 'Your claim was accessed based on the submission by Gleneagles and paid in accordance with the benefits provided under the policy. Unless Gleneagles establishes that there is a change in the classification of the charges and re-submits the e-filed claim, we will not be able to pay a higher amount.'
Is the insurer, Ministry of Health or CPF Board responsible for auditing the rules hospitals use in the classification of hospital charges? Is the detailed claim settlement not retrievable from the central processing system?
Cheam Teo Seng (Ms)
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