Coverage for non-subsidised treatments would mean higher premiums

11 May 2007, The Straits Times

Question

Name of the Person: Paul Chan Poh Hoi

Allow claims for pre- and post-op expenses

I REFER to the reply of the Ministry of Health's Ms Karen Tan ('Right to conserve Medisave for big bills'; ST. April 27) and wish to seek her views on MediShield claims by patients who incurred costs pre-and post-operation under the restructured MediShield policy.

My recent cataract operation at the Singapore National Eye Centre on both eyes is a classic example of an anomaly. I could have opted for the operation via the polyclinic route and saved a lot of money as it is day surgery but I went in as a private patient. The end result was that I got only $191 for an operation that cost over $7,200. The payout does not commensurate with the annual premiums paid over so many years.

What amazed me is that pre- and post-operation treatment costs were not considered as part of the total costs to be claimed as a package.

Why is this so? Without a prior examination, the surgeon could not decide whether to operate. And without close monitoring immediately after the operation, the surgeon would not know the results. It defies logic to deny such claims as the consultations were inseparable in the train of events. The crux of the problem is the selective eligibility for MediShield payout. This practice runs counter to the spirit of fair compensation. I would agree that MediShield excludes follow-up treatment costs after the surgeon has certified that the operation was successful and complete. It is unfair to policyholders to exclude legitimate medical costs for the sake of exclusion.

Reply

Reply from MOH 

In “Allow claims for pre- and post-ops expenses,” (ST, 5 May) Mr Paul Chan was puzzled why his MediShield only paid $191 for his eye operation which cost over $7,200.  Mr Chan bought a basic MediShield policy which is meant to cover the subsidised Class B2/C hospitalisation.  If he wished for insurance coverage for non-subsidised hospitalisation, he would have to buy the enhanced MediShield products which would naturally cost more in premium.

Mr Chan also asked that MediShield be extended to cover outpatient expenses.  Besides coverage for hospitalisation, MediShield does allow claims made for dialysis, chemotherapy, day-surgery, pre-admission tests that are directly related to the surgeries and pre-surgery tests, subject to the claim limits.  However, MediShield does not cover other outpatient expenses as it would mean higher premiums.