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Medical Claim Issues (Again...)

>> Friday, December 4, 2009

Extracted from ST Forum:

Puzzled by insurer's payout for medical claim

RECENTLY, my wife was hospitalised at Mount Alvernia Hospital for four days. Her medical bill came up to $7,995.15.

She is insured under Income's IncomeShield Plan MA, but the total payout by Income was a shocking $240.

I called Income to find out how it arrived at that sum and was told that technically the $7,995.15 was classified as "room and board", hence limiting the claim.

The $7,995.15 included a renal screen, bed charges, clinical consumables and supply, diagnostic imaging services, equipment use, laboratory services, outside hospital services, pharmacy cost, resident medical officer fees, treatment fee and doctor attendance fee.

Given a deductible of $4,000 per policy year and 10 per cent co-insurance, any man in the street would expect an insurance payout of $3,595.63. But this is not the case.

My wife has faithfully paid her premium for the past 15 years without a single claim and this is what she gets in return. I am writing this so the public is made aware of such pitfalls in their medical insurance.

For big insurance companies to cite a technicality as an excuse not to make a decent payout is in no way fair. I urge the Consumers Association of Singapore and leaders in the insurance industry to look into this loose definition of "room and board".

In my opinion, given my wife's good record, Income should honour the $3,595.63 payout as a goodwill gesture.

Lastly, I would like to ask the Central Provident Fund Board why only $450 a day can be used from Medisave for hospitalisation.

Ong Kok Lam

---

Yet another case of ignorance. Complaining only when it is too late.

Income will probably reply soon, but their response will include:
1. IncomeShield Plan MA is for Government A Class ward, not private. So, it will be pro rated. Rich enough to stay private, yet never get the corresponding coverage...
2. IncomeShield has many many limits on the various items. So, it will be claimable amount will be further reduced. Should have upgraded to Enhanced IncomeShield. Well, too late now that you already have a medical history...
3. After applying the deductable and co-insurance on the already very small claimable amount after the above deduction, they are fortunate to even claim anything...

Another well to do couple trying to save the penny and cents from a good hospital plan and not willing get proper advice from good financial consultants. Sigh... Even after a case being brought up in the forum every few months, nobody learns...

Insurance, something that many feel is always too much when buying and never enough when claiming.

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