Insurance claim e-filing: MOH replies

MOH's Reply

Straits Times, 1 Apr 2016

Insurance claim e-filing: MOH replies

Dr Thomas Lee Hock Seng asked why the Ministry of Health (MOH) does not allow private specialist clinics to do e-filing for insurance claims on behalf of patients, and why insurers are prohibited from processing, or are allowed to refuse, claims without e-filing ("Cut costs by letting clinics e-file for insurance"; March 23).

All Medisave and MediShield Life claims have to be e-filed to ensure accountability and efficiency in claims processing, due to the high volumes involved.

All clinics, including private specialist clinics, are allowed to e-file for day surgery claims, as long as both the facility and the doctor carrying out the surgery are Medisave/MediShield Life accredited.

Medical institutions/clinics and doctors are required to be accredited by MOH before Medisave and MediShield Life claims can be submitted, to ensure that there is accountability in making claims for their patients.

Different insurers may have different claims assessment requirements for private insurance coverage.

Applications for Medisave/MediShield Life accreditation can be done online at MOH's online Medisave accreditation application website (https://www.mediclaim.moh.gov.sg/mmae/OverviewApplication.aspx).

We thank Dr Lee for his feedback.

Ms Lim Bee Khim
Director, Corporate Communications
Ministry of Health

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Forum Letter

Straits Times, 23 Mar 2016

Cut costs by letting clinics e-file for insurance

Last Thursday's report ("New B1 insurance plan fails to address some concerns") highlights some of the inadequacies of an attempt to standardise Integrated Plans (IP) beyond MediShield Life to make them affordable.

But there are other significant shortcomings in the way the Ministry of Health (MOH) enforces e-filing for insurance claims for MediShield Life-linked IPs.

Let me highlight one anomaly.

Currently, only hospitals are authorised by MOH to do e-filing for insurance claims on behalf of patients. Specialist clinics in private hospitals, with their own in-house facilities for day surgery, are not equipped to do this.

So, if a patient at a specialist clinic wants to claim insurance for a day surgery procedure, he has to switch to the private hospital's surgical facility, causing costs to almost double.

Day surgery, which is recognised as a very effective cost-control measure, is increasingly adopted by various specialist providers.

The solution is for MOH to equip specialist clinics in private medical centres with e-filing capability.

Otherwise, for patients to make their insurance coverage meaningful, they would have to resort to using the more expensive option of having the specialist do the day surgery at the hospital.

This is a simple way to keep healthcare costs reasonable.

What is keeping MOH from allowing private specialist clinics to do e-filing? And why are insurers prohibited from processing, or are allowed to refuse, claims without e-filing?

Thomas Lee Hock Seng (Dr)