Mr. Wee (not his real name) is in his late 50s. On advice from his friends, he upgraded his Medishield to a private Shield and paid a higher premium. He thought that this would provide higher coverage for his medical expenses, but it turned out to be a nightmare for him.
A few months later, he had a heart condition that required him to be hospitalized on three occasions. Although his private Shield plan allowed him to use B2 ward, he opted for C class ward. The total bill for the three visits was $14,000, which was initially deducted from his Medisave account.
The insurer refused to pay the claims on account of non-declaration of a cancer treatment that occurred 20 years earlier. As there was no recurrence of this problem, Mr. Wee thought that it was a non-issue. The insurer also found that he did not declare his high blood pressure that was under control.
Mr.Wee had been insured under Medishield since its inception. Instead of paying the claims (which is fully recoverable from Medishield), the insurer wanted to cancel the private Shield insurance from inception, and required Mr. Wee to make a claim directly from Medishield But Medishield told Mr. Wee that he should claim under his private Shield, as Mr. Wee had transferred his policy to private Shield for half a year. It would be quite difficult to transfer the insurance back to Medishield retrospectively.
Mr. Wee had to move from one party to another and after a few months, his claim was still not paid. He advised the public not to upgrade to a private Shield from Medishield and faced this type of stress.
A few months later, he had a heart condition that required him to be hospitalized on three occasions. Although his private Shield plan allowed him to use B2 ward, he opted for C class ward. The total bill for the three visits was $14,000, which was initially deducted from his Medisave account.
The insurer refused to pay the claims on account of non-declaration of a cancer treatment that occurred 20 years earlier. As there was no recurrence of this problem, Mr. Wee thought that it was a non-issue. The insurer also found that he did not declare his high blood pressure that was under control.
Mr.Wee had been insured under Medishield since its inception. Instead of paying the claims (which is fully recoverable from Medishield), the insurer wanted to cancel the private Shield insurance from inception, and required Mr. Wee to make a claim directly from Medishield But Medishield told Mr. Wee that he should claim under his private Shield, as Mr. Wee had transferred his policy to private Shield for half a year. It would be quite difficult to transfer the insurance back to Medishield retrospectively.
Mr. Wee had to move from one party to another and after a few months, his claim was still not paid. He advised the public not to upgrade to a private Shield from Medishield and faced this type of stress.
9 comments:
Well, this is Singapore, where people will spend $10 to find out where will their $1 goes to.
Such cases and the name of the insurer involved should be made known to the public.
Insurers have a right to their commercial practices.
But likewise, the public should also be made aware of such commercial practices. So they can make good decisions with their eyes wide opened.
The entire matter could have been avoided if Mr Wong was allowed to continue to insure himself under Medishield AND take up the additional private shield plan.
Why cannot I really don't know.
Uniquely Singapore?
What about the insurance agent?
Did the agent conduct a thorough fact find and counseling? Did the agent warn him of the need for full disclosure; material medical information that he knew and which he ought to know. It is very often also the fault of the agent who is only interested in the closing the case that the agents would avoid the warning.
I have known of many cases that were been twisted by insurance agents and resulted in exclusions because of the initial high 1st year commission.
MAS must do something about this unethical practice. Agents like them should be hauled up and their license revoked.
Talking of rice bowls being broken when moved to fee based? This is exactly the type of agents whose rice bowl should be broken.
Firstly what was an accident is now called "collision" so that payment can be denied while premiums were pccketted these years.
Now we have Insurer refusing to pay even when there was full coverage under Medishield Basic.
All those who insured under CPF Medishield were transferred either to NTUC Income or GE. The instruction given by CPF was that these second-hand insurers must avail themselves as one-stop service provider.
Why is then Mr Wee be pushed around when it is clearly Income? who is to sort all the matter and pay up (they can partial claim from CPF later...). A simple, straight forward matter is made so convoluted. I hope it is not some tricky move to deny Mr Wee his dues.
Another "collision" and NOT accident?
Another area where Insurers are exploiting to push away claims are for "Day Surgery" claims...Now more ops are done under "Day Surgery" scheme.
And Insurers are pushing away such claims as they are not considered as "hospitalisation" of more than 6hours.
The problem is compounded when Doctors are telling patients that they could claim from the private Shields or other insurance policies.
Patients better check before hand but Insurers are not giving clear advice.
Unknowingly those who are actually "subsidised" patients and switched to "privatised" status (in case of follow-up ops due to complications) or if they selected their doctors for the day surgery would end up paying paying unsubsidised rates and the Insurers would conveniently push away all claims from "day surgery" and in case of complications - further outpatient treatment costs.
Quite alot in the "excess" ended up being absorbed through the patients' own pockets including the full "day surgery" costs.
Why is our Govt not aware of this?
I think it has become a game of pushing away costs, between the Insurers and Govt Hospitals.
Soodo shud guess that Insurer is either GE or NTUC Income.
Having some unpleasant experience with the latter, I wud guess Mr Wee's problems to be with INCOME....
Makes you wonder why bother buying insurance, you've got to plough through a minefield with a comb to preempt your insurer to pull a fast one on you.
Looks like TKL is right after all, when you are old, heck, why bother buying Medishield Insurance, may as well have own contingency savings and opt for Class 3 bed.
Better than paying premiums for a lifetime, then can't claim from your own private Medishield insurer.
Is it right to say it was CPF's fault for abandoning us, and push us to the private shield providers, GE and NTUC Income? Could we go back to Basic Medishield with the irresponsible CPF Board?
Hi yujuan,
Did you criticize me before for suggesting that it is better to be self insured?
Anyway, I think that it is okay to stay on Medishield and, to pay for anything that is not covered by Medishield out of savings (Medisave or cash).
And it is best to go for C or B2 class ward - for the elderly.
"Mr. Wee" sent his letter to the Straits Times and Today. They declined to publish it. The name of the insurer is stated in the letter. Most of you guessed the insure correctly!
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