Hell Minister paid only $8 for bypass due to MediShield

[PTADER]

An example of the cost of a similar treatment carried out six years ago in 2004 on a B2 class non civil servant patient.


**********************************************************

New subsidy saves heart patient $800

147th Prostitute Press, Tabloid Division(New Paper)
4 July 2004


THE heart attack hit him like a sledgehammer. At 36 years of age, it was the last thing Mr Sammy Tan expected.

After the emergency treatment, angiogram and angioplasty - he had a stent put in - he found himself about $2,000 poorer.

He will be going for a second angioplasty for a second blocked artery - tiny balloons will be put into the narrowed artery to stretch them open - on Tuesday. And he may need a second stent put in.

And it will be just in time for the new Medical Service Package (MSP), which starts on Monday.

The Health Ministry is introducing the pilot project starting with cardiology and cardiothoracic services for inpatient and day surgery in public sector institutions.

There is now a $500 subsidy cap on devices such as heart stents, defibrillators and pace-makers and little or no subsidy for some new drugs for heart conditions.

With the new package, B2+ and B2 class patients will get 65 per cent subsidies for these devices and drugs while C class patients will get 80 per cent subsidies.

On Tuesday, Mr Tan, a B2 class patient, may well find his bill several hundred dollars less than before.

A bare metal stent, like the one he had implanted into one of his arteries on May 21, costs $2,000.

With the old subsidy cap of $500 for heart devices, he had to fork out $1,500 from his own pocket just for the stent.

HE CAN SAVE $800

With MSP, the subsidy for the stent will be 65 per cent of the cost, which works out to $1,300. So Mr Tan may need to pay only $700 for the stent, $800 less than before.

On May 21, the money broker had just finished working out at his Shenton Way gym when he felt 'extremely terrible'. Cold sweat started to pour off him.

At 72kg and 1.76m tall, he was not overweight. And for the past few months, he had been working out at the gym three to four times a week.

The gym manager called a taxi and accompanied him to the Accident and Emergency Department at Singapore General Hospital.

After an angiogram, in which a dye visible on X-rays was injected into his heart arteries in order to see where they had narrowed, doctors found one artery totally blocked. Another artery was 88 per cent blocked.

Mr Tan ended up with a bill of over $5,000 for a five-day stay in hospital. After Medisave and Medishield, he paid about $2,000.

'On Tuesday, when they work on my artery with the 88 per cent blockage and find that they need to put in a stent as well, I will look forward to paying less,' he said.

DOCTORS TO CHECK EACH OTHER WHEN USING SOME TREATMENTS

The MSP introduces a system of peer review (doctors checking each other) to ensure that patients receive the correct treatment.

It will apply only to subsidised patients (B2+, B2 and C class) and cover procedures, devices and drugs in three categories.

Basic - health services that are standard, where there is nothing controversial. No peer review is necessary.

Extended - the more controversial, or advanced and newer medical services. A peer review system will be developed within each department to monitor indications and usage.

Excluded - non-essential medical services such as cosmetic surgery and experimental and unproven treatments.

 

[Char_Azn]

An example of the cost of a similar treatment carried out six years ago in 2004 on a B2 class non civil servant patient.

The cow probably bought additional coverage on top of his medishield and medisave so the insurance company pays the balance, for your example, I think he didnt do it. It's not ex, I pay something like >$30 a month those enhanced medisave plan(check with your insurance agent) and my hospital bills are basically 100% covered

 

[aurvandil]

You stupid communist. He said it was paid by a Private Health Insurance Plan!!

Many people buy medical insurance and think that they are "protected".

Every year, they pay large amounts of premium.

Then one day they get hospitalised.

They get a rude shock when they find the insurance company rejecting their claim due to all sorts of reasons not made known to them when they purchased the policy.

In the case of mighty Minister Khaw, is there any insurance company in Sg that dare reject his claim?

 

[aurvandil]

The following is a case study from Tan Kin Lian.

http://tankinlian.blogspot.com/2010/10/rejected-claim-under-private-shield.html

A retiree went to renew his motor insurance. The agent advised him to convert from Medishield to private Shield.

A few months later, he was hospitalised for removal of stones in his body. As he was insured under class A, he opted for A class. His bill was $7,000.

The insurance company checked with the polyclinic where he had been treated before and learnt that he was suffering from diabetes.

This condition was not declared in the application for the Shield insurance.

The claim was rejected

The retiree was not aware of this medical condition, as it was not notified to him by the polyclinic and was not placed under medication.

When he was hospitalised, he was asked if he suffered from diabetes, and he said “no”. He would not have lied, as it would have been risky for him to be operated.

His appeal to the insurance company was rejected.

They asked him to file a complaint with FIDREC for an independent adjudication.

They also voided his Shield policy from inception. He is not insured under the Shield plan anymore.

 

[Char_Azn]

The insurance company checked with the polyclinic where he had been treated before and learnt that he was suffering from diabetes.

This condition was not declared in the application for the Shield insurance.

http://tankinlian.blogspot.com/2010/10/rejected-claim-under-private-shield.html

This part is very important. He did not declare to the insurance company. Normally if you declare, the insurance company will assess the situation and tell you what is covered and what is not covered.

He claimed that the polyclinic did not inform him that he is diabetic, which I seriously doubt, its not like a common flu, it's freaking diabetes which requires constant attention to your own health. If he was really not informed by the polyclinic about his condition, the logical choice here is to sue the polyclinic for negligence

 

[aurvandil]

This part is very important. He did not declare to the insurance company. Normally if you declare, the insurance company will assess the situation and tell you what is covered and what is not covered.

He claimed that the polyclinic did not inform him that he is diabetic, which I seriously doubt, its not like a common flu, it's freaking diabetes which requires constant attention to your own health. If he was really not informed by the polyclinic about his condition, the logical choice here is to sue the polyclinic for negligence

The scam here is that the insurance company does not check until you make a claim.

Hence if you have a pre-exisiting condition but you don't make a claim, the insurance company will happily take your money.

However if you make a claim, the insurance company will investigate you thoroughly and look for all sorts of excuses to reject your claim.

Thanks to practices like this, the approximate payout ratio for medical insurance is only $0.60 to $0.70. This means that for every $1 that the insurance company collects in terms of permium, they only pay out between $0.60 to $0.70.

The odds of you "earning" from a medical insurance policy are therefore even lower than playing jackpot at MBS/RWS !!!

When you play jackpot at MBS/RWS, the law requires the casino to give you a minimum payout of $0.90.

 

[Ramseth]

A retiree went to renew his motor insurance. The agent advised him to convert from Medishield to private Shield.

A few months later, he was hospitalised for removal of stones in his body. As he was insured under class A, he opted for A class. His bill was $7,000.

The insurance company checked with the polyclinic where he had been treated before and learnt that he was suffering from diabetes.

This condition was not declared in the application for the Shield insurance.

The claim was rejected

The retiree was not aware of this medical condition, as it was not notified to him by the polyclinic and was not placed under medication.

When he was hospitalised, he was asked if he suffered from diabetes, and he said “no”. He would not have lied, as it would have been risky for him to be operated.

His appeal to the insurance company was rejected.

They asked him to file a complaint with FIDREC for an independent adjudication.

They also voided his Shield policy from inception. He is not insured under the Shield plan anymore.

I think TKL is too prone to pro-client anti-agent after his removal from NTUC Income. It's clearly not advisable to switch Shield plans with a pre-existing condition. But did the client tell the agent? Of course not, since he claimed the polyclinic didn't tell him at all. Did the polyclinic not tell him? I doubt so. Have you ever heard of anyone being diagnosed with diabetes and not told by the doctor? If so, he should sue the polyclinic and the doctor. It's a professional must to tell as it entails follow-up medication and instruction on dietary restriction.

TKL seems to have short memory after leaving the insurance industry for just a few years. An insurance company cannot reject a claim based on undeclared pre-existing condition unless there's documented proof the client should have known but didn't delcare anyway.

 

[aurvandil]

If the person if Mr Tan's case study was Minster Khaw, the insurance co would probably not have checked. They would have just paid up. Or are you saying they would have checked up and rejected his claim at the slightest pretext.

 

[Ramseth]

If the person if Mr Tan's case study was Minster Khaw, the insurance co would probably not have checked. They would have just paid up. Or are you saying they would have checked up and rejected his claim at the slightest pretext.

All insurance companies have claim departments with lawyers, adjustors and investigators. All cases will be assessed. Usually it's routine unless anamolies show up. E.g. a claim based on diabetes whereas diabetes wasn't declared on the form, they'll check for when was the first diagnosis. If they don't check, then I worry. If the diagnosis date was later than the claim date, they'll pay out the claim. If there hasn't been any diagnosis before, then the benefit of doubt is given to the claimant, pay out also.

 

[aurvandil]

All insurance companies have claim departments with lawyers, adjustors and investigators. All cases will be assessed. Usually it's routine unless anamolies show up. E.g. a claim based on diabetes whereas diabetes wasn't declared on the form, they'll check for when was the first diagnosis. If they don't check, then I worry. If the diagnosis date was later than the claim date, they'll pay out the claim. If there hasn't been any diagnosis before, then the benefit of doubt is given to the claimant, pay out also.

That doesn't answer the question. Let's try again.

If the person in the case study was Minister Khaw, would the insurance co have

1) Checked up on him
2) Rejected his claim
3) Rejected his appeal
4) Told him to go to FIDREC if he was not happy.

 

[Ramseth]

That doesn't answer the question. Let's try again.

If the person in the case study was Minister Khaw, would the insurance co have

1) Checked up on him
2) Rejected his claim
3) Rejected his appeal
4) Told him to go to FIDREC if he was not happy.

(1) Yes.
(2) Reject only on valid grounds.
(3) Reject only on valid grounds.
(4) His claim was valid and approved, go FIDREC for what?

 

[aurvandil]

(2) Reject only on valid grounds.
(3) Reject only on valid grounds.

WOW ... How nice to know we live in such a fair and equal society !!!

 

[aurvandil]

Tan Kin Lian has done a blog posting about how insurance companies in SG are very ""trigger happy" to reject claims.

Risk of Private Shield

http://tankinlian.blogspot.com/2010/11/risk-of-private-shield.html

I have seen several examples of the problems encountered by consumers when they change from Medishield to Private Shield or from one Private Shield to another plan. They encountered rejection of their claim due to failure to disclose previous medical conditions. In some cases, the previous medical conditions were quite trivial and are not material to merit rejection of the claim. However, the claim officer is "trigger happy" in rejecting the claims, so that they can make more profit for the insurance company.

The purpose of insurance is to pay claims, especially for legitimate claims. It is not to make excessive profit for the insurance company. In some countries, it is illegal for an insurance company to reject a claim for unjustified reasons. If they wish to cite "non-disclosure", they need to have reasonable grounds. As the situation seem to be quite bad in Singapore, it is best for consumers to avoid changing insurers or to avoid upgrading of Shield plans.

The behavior of the insurance company is bad in another respect. Even if they are entitled to reject the claim, it is still their duty to pay the Medishield portion of the claim, as this cover is supposed to continue from one insurer to another, and from one plan to another. By rejecting the claim, the insurance company is failing in its duty to treat its customer fairly.

If you are caught in this situation, and your claim is unfairly rejected, you have the following options:


•Lodge a complaint to FIDREC (www.fisca.sg) for your claim to be mediated or adjudicated
•Write a letter to the newspaper to complain about the unfair rejection
You can read several stories about unfair rejection of Shield claims in my website. Go to www.tankinlian.com/ask.aspx and search for 'Rejection" or "Shield".

 

[SotongMee]

Wa-say, imported talent after heart-by-pass Cow now more like kiasu Sinkies, "Wa so cheeep $8 only !" Like dat Can have second round man!

"Choy diu guai nie tai gut le si" (Cantonese) Cheapskake Cow!

More Singaporeans covered by health insurance

Health Minister Khaw Boon Wan said 88 per cent of all Singaporeans are now protected by MediShield, and that its coverage is growing.

Writing in his blog, the minister said the number of uninsured young Singaporeans has gone down by more than half to 17 per cent last year, as compared to the percentage in 2007.

This was done through reaching out to the young Singaporeans in schools.

Among MediShield policyholders, Mr Khaw said 58 per cent have topped up with a private shield plan for hospitalisation in Class A and private hospitals.

Meanwhile, subscription to ElderShield has increased from 789,000 in 2007 to 906,000.

He said few Singaporeans now opt out of ElderShield, when they cross the age of 40.

And among the ElderShield policyholders, 19 per cent have topped up with private ElderShield supplements, to enjoy a higher payout.

Mr Khaw also revealed that his out-of-pocket expense for his recent bypass surgery was only S$8.

He said his hospital bill was largely paid by MediShield and a private Shield supplement.

Medisave took care of the bill's co-payment.

The minister said he's looking at ways to strengthen health insurance further.

Mr Khaw said at an informal lunch with health insurers on Monday, that several ideas were floated.

They included extending MediShield to include mental illness, congenital illness and neo-natal treatment.

There were also comments on raising the claim limits on outpatient cancer care, so as to relieve the burden on cancer patients.

For ElderShield, Mr Khaw said there was discussion on how to raise the monthly basic payout from S$400 and to extend the payout period beyond six years.

He also said there was discussion on how to discourage over-charging, and how to take advantage of the lower cost providers overseas.

 

[rofthelper]

But based on the picture I saw in may, he seems to stay at A class ward leh? How come only pay 8 bucks? A/B1 class sure got pay deposit upfront one. He no need to pay?

http://www.healthxchange.com.sg/News/Pages/Heart-Bypass.aspx

Knn, I must ask my life planner abt this. :oIo:

 

[rofthelper]

http://www.facebook.com/note.php?note_id=500175045389&id=154909330630&ref=mf

Health Minister’s total bill for his bypass surgery came up to about $25,000; of which $20,000 was paid by insurance, and $5,000 by Medisave. Minister had subscribed to Basic MediShield (since it was launched in 1990) and topped it up with a private Medisave-approved Shield which covers Class A and private hospitals. He did not have any riders. The insurance premium for someone in his age range (51-60 years old) is about $330 - $662 for a Shield plan targeted at Class A hospitalization. Presently, one can use up to $800 per policy per year from Medisave to pay for Medisave-approved Shield plans.

Really so cheap meh?

 

[halsey02]

Wa-say, imported talent after heart-by-pass Cow now more like kiasu Sinkies, "Wa so cheeep $8 only !" Like dat Can have second round man!

"Choy diu guai nie tai gut le si" (Cantonese) Cheapskake Cow!

"Pang yeow", this is not buffet you know, and you have only one HEART!

 

[PTADER]

The cow probably bought additional coverage on top of his medishield and medisave so the insurance company pays the balance, for your example, I think he didnt do it. It's not ex, I pay something like >$30 a month those enhanced medisave plan(check with your insurance agent) and my hospital bills are basically 100% covered

http://www.sgh.com.sg/Patient-Services/Pages/frequently-asked-questions.aspx#civil


Civil Service Card Holders


Who are the holders of Civil Service Card (CSC) or the Medical Benefit Identity Memo (MBIM)?

Government officers, pensioners and their dependants who are treated at SGH.

What do I need to do during registration?

You need to produce the CSC/MBIM and Identity Card to the Admissions Staff handling your admission. You will also need to complete a copy of the Medisave Authorisation Form if you wish to use your Medisave to cover any hospital charges not covered by your Civil Service Medical Benefits.

Can I opt for a ward class that is outside my medical entitlement?

If you seek to admit to a class of ward accommodation higher than your class entitlement stated in the CSC or MBIM, you will need to pay additional fees as specified by your Medical Benefit Scheme.

How do I settle my hospitalisation charges?

After your discharge, your Ministry or Government Department will settle the charges covered by your Civil Service Medical Benefits (CSMB). If you have completed the Medisave Authorisation Form, the hospital will submit the bill directly to the CPF Board who will pay the portion not covered by CSMB through deduction from your Medisave account. You may pay the difference by cash, cheque, NETS or credit card if you have insufficient Medisave savings.

What is the "Co-payment of Ward" (CPW) scheme?

Under this scheme, when a CSC holder or his dependent admits to his class of entitlement, he pays 20% and his dependent pays 50% of the ward charges. However, if the patient seeks to admit to a higher class, he or his dependant will pay 100% of the ward charges. The rest of the hospital fees are billed to his employer.

What about the Comprehensive Co-payment Scheme (CCS)?

Under the CCS scheme, CSC holders and their dependants will co-pay on all the services that are currently reimbursable. The co-payment percentages for CSC holders and their dependants are 15% and 40% respectively if they seek to admit to their class of entitlement. In the event that the patient upgrades to a higher class, a higher percentage of co-payment will be applicable.

What is the MSO scheme?

The MSO refers to "Medisave cum Subsidised Outpatient" scheme. All newly recruited civil servants as from 1 Jan 1994 fall under this scheme.

How does the Medisave-cum-Subsidised Outpatient (MSO) scheme work?
The government contributes 1% of gross monthly salary to employees' Medisave accounts up to a maximum of $70 per month. As the patient has no hospitalisation benefits, he has to use his Medisave to settle the hospital bill.