Claims return rates for Integrated Shield Plans

[Solid_snape]

i was browsing through MOH website looking at the comparison between the different insurers in Singapore and saw this table:

imgur.com/b5lkJdv (I can't post images yet )

Source: h t t p s ://w w w .moh.gov.sg/content/moh_web/medishield-life/integrated-shield-plans/comparison--of-integrated-shield-plans.html

One thing that stands out is the success rate of Great Eastern and it does seem quite terrible in comparison with the others which mostly average in the high 80s to 90s

So I was wondering if anyone has any experience personally as it looks like there seems to something wrong if Great Eastern has such a low success rate..
Wouldn't it be rather frustrating and I am considering switching to a different company if this is true..

thanks in advance for any input and discussion..

 

[Perisher]

i was browsing through MOH website looking at the comparison between the different insurers in Singapore and saw this table:

imgur.com/b5lkJdv (I can't post images yet )

Source: h t t p s ://w w w .moh.gov.sg/content/moh_web/medishield-life/integrated-shield-plans/comparison--of-integrated-shield-plans.html

One thing that stands out is the success rate of Great Eastern and it does seem quite terrible in comparison with the others which mostly average in the high 80s to 90s

So I was wondering if anyone has any experience personally as it looks like there seems to something wrong if Great Eastern has such a low success rate..
Wouldn't it be rather frustrating and I am considering switching to a different company if this is true..

thanks in advance for any input and discussion..

https://www.moh.gov.sg/content/moh_...s/comparison--of-integrated-shield-plans.html

Nice data.

 

[chopra]

i was browsing through MOH website looking at the comparison between the different insurers in Singapore and saw this table:

imgur.com/b5lkJdv (I can't post images yet )

Source: h t t p s ://w w w .moh.gov.sg/content/moh_web/medishield-life/integrated-shield-plans/comparison--of-integrated-shield-plans.html

One thing that stands out is the success rate of Great Eastern and it does seem quite terrible in comparison with the others which mostly average in the high 80s to 90s

So I was wondering if anyone has any experience personally as it looks like there seems to something wrong if Great Eastern has such a low success rate..
Wouldn't it be rather frustrating and I am considering switching to a different company if this is true..

thanks in advance for any input and discussion..

Took me a while to understand the definition.

By 4th week, all in 80s 90s la.

 

[shingy]

Don't be too reliant on the statistics. MOH update the info every now and then. The last time I checked it is AIA with poor claim performance.

 

[axxomarketing]

they took it out already from the website.

 

[Bigoya]

Every day definitely there will be new patients being admitted to our hospitals country wide in Singapore, and I'd believe most of them actually have Integrated Shield plan with a good % signed up with each IPs provider.

If the claims experience are poor, I believe we're likely to see more news articles than what we've already seen, especially posts that goes viral on facebook.

I personally presume that the claims rate for all 6 insurers should be fine, sometimes claims issue arises are really based on case by case basis, perhaps declarations upon applications has not been made truthfully, so severely misleading such that even insurance companies want to close an eye also can't.

Sometimes it may be due to one or two policyholder's misunderstanding about the procedures and made an impulsive rant online, only to be resolved eventually (even if the rant didn't occur).
I have came across people who complains about not being able to claim a $2k+ hospital bill, not knowing that the sum falls within the deductibles and that they do not actually have the rider attached to their plan.

If any companies' claims experience are really bad, they'd have gone defaulted long ago as policy holders would lapse their existing policies and make a big fuss over the internet.

These are just my personal opinions as an insurance agent and also as a consumer, based on observations and experience, just some food for your thoughts.

 

[wahkao3]

so how????

 

[Shion]

Thanks for sharing

 

[akwl88]

How come bo statistics for rejection of premiums one?

Guranteed to pay premiums but no guranteed to claim?

 

[windwaver]

Nice data.

Seems that by the 4th week, this is the ranking from best to worse

1) Prudential
2) NTUC
3) Aviva
4) AIA
5) Great Eastern

You might also want to compare how much each insurance companies charge for their plans in order to make a better comparison before jumping ship.

 

[windwaver]

If any companies' claims experience are really bad, they'd have gone defaulted long ago as policy holders would lapse their existing policies and make a big fuss over the internet.

There will also be people that can't be bothered to go after the insurance companies and just complain.

Anyway, insurance companies will always push the blame to doctors. Doctors will tell patients that they are not trained to write for insurance claims.

In the end, the patient suffer, both physically and $$ wise.

I suggest just sticking to B1 restructured with a rider to cover co-pay and deductibles. If cannot afford at old age, the basic medishield life will do as it covers all pre-existing conditions.

 

[dgeralds]

Exactly. I have this problem for sometime though the insurance company pays me at the end (AFTER DING DONG A NUMBER OF MONTHS), at least at this point in time.

But no problem for those hospital policy in my family that have 100% cover with rider...

There will also be people that can't be bothered to go after the insurance companies and just complain.

Anyway, insurance companies will always push the blame to doctors. Doctors will tell patients that they are not trained to write for insurance claims.

In the end, the patient suffer, both physically and $$ wise.

I suggest just sticking to B1 restructured with a rider to cover co-pay and deductibles. If cannot afford at old age, the basic medishield life will do as it covers all pre-existing conditions.

 

[dgeralds]

Wow! You have great faith in the system. Wait until it hits you then you will wake up.

Fyi, I'm already hit and have woken up...

Every day definitely there will be new patients being admitted to our hospitals country wide in Singapore, and I'd believe most of them actually have Integrated Shield plan with a good % signed up with each IPs provider.

If the claims experience are poor, I believe we're likely to see more news articles than what we've already seen, especially posts that goes viral on facebook.

I personally presume that the claims rate for all 6 insurers should be fine, sometimes claims issue arises are really based on case by case basis, perhaps declarations upon applications has not been made truthfully, so severely misleading such that even insurance companies want to close an eye also can't.

Sometimes it may be due to one or two policyholder's misunderstanding about the procedures and made an impulsive rant online, only to be resolved eventually (even if the rant didn't occur).
I have came across people who complains about not being able to claim a $2k+ hospital bill, not knowing that the sum falls within the deductibles and that they do not actually have the rider attached to their plan.

If any companies' claims experience are really bad, they'd have gone defaulted long ago as policy holders would lapse their existing policies and make a big fuss over the internet.

These are just my personal opinions as an insurance agent and also as a consumer, based on observations and experience, just some food for your thoughts.

 

[windwaver]

Exactly. I have this problem for sometime though the insurance company pays me at the end (AFTER DING DONG A NUMBER OF MONTHS), at least at this point in time.

But no problem for those hospital policy in my family that have 100% cover with rider...

Wow! You have great faith in the system. Wait until it hits you then you will wake up.

Fyi, I'm already hit and have woken up...

Unfortunately the insurance industry is smart. Young people that are paying the premiums will not understand the situation until they get older.

Older folks who have been paying premiums for a few decades will know how tough it is when the actual claim happens (when you are sick).

It's always seamless when you pay premiums but don't expect the same when claiming.

The tai chi game between insurance companies and doctors will always lead to patients suffering.

 

[Bigoya]

Wow! You have great faith in the system. Wait until it hits you then you will wake up.

Fyi, I'm already hit and have woken up...

Mind sharing the full details of what happened? I'm pretty sure your experience can benefit everyone and help them make better decisions.

 

[akwl88]

There will also be people that can't be bothered to go after the insurance companies and just complain.

Anyway, insurance companies will always push the blame to doctors. Doctors will tell patients that they are not trained to write for insurance claims.

In the end, the patient suffer, both physically and $$ wise.

I suggest just sticking to B1 restructured with a rider to cover co-pay and deductibles. If cannot afford at old age, the basic medishield life will do as it covers all pre-existing conditions.

Real life exp with doc, she said that insurers make it complicated for patients to claim with their troublesome requirements

 

[dendii]

It goes both ways.

Insurers have to ask the relevant questions for claims. And likewise, doctors need to provide them. Windwaver is exactly right. For the process to be seamless, all the parties involved need to do their part. If not, it will be the consumers who suffer.

You kept asking why premiums guaranteed claim are not? If claims are guaranteed, then there are going to be alot of false claim cases. Thats just human nature.

Before you ask then why cant request for people to do medical examination before insuring them?

If this were to happen, chances are there will be quite a number of people not being insured since whatever is wrong is already diagnosed. Who is going to be responsible for that?

Is there a better way to do things? I cant think of any but i am sure all of us are all ears for your suggestion.

Real life exp with doc, she said that insurers make it complicated for patients to claim with their troublesome requirements

 

[akwl88]

It goes both ways.

Insurers have to ask the relevant questions for claims. And likewise, doctors need to provide them. Windwaver is exactly right. For the process to be seamless, all the parties involved need to do their part. If not, it will be the consumers who suffer.

You kept asking why premiums guaranteed claim are not? If claims are guaranteed, then there are going to be alot of false claim cases. Thats just human nature.

Before you ask then why cant request for people to do medical examination before insuring them?

If this were to happen, chances are there will be quite a number of people not being insured since whatever is wrong is already diagnosed. Who is going to be responsible for that?

Is there a better way to do things? I cant think of any but i am sure all of us are all ears for your suggestion.

The hosp liase straight with the insurers so both parties know what they want, instead of gg through the consumer as middleman and ding dong here and there

funny there is no mention of agent's part in your comment

 

[Bigoya]

The hosp liase straight with the insurers so both parties know what they want, instead of gg through the consumer as middleman and ding dong here and there

funny there is no mention of agent's part in your comment

As far as I'm aware of, most hospitals (if not all) does direct e-filing with insurers for shield claims. Patients and agents are not even involved in the primary claims process. Correct me if (you have valid updated evidence to proof that) I'm wrong?

It is when insurers require additional details whereby hospital are unable to provide, then the request would be directed to the insured, which I think this is the only way to solve problems. Who else would have better details on the insured's health rather than the insured themselves?

Just an example out of the many possible scenarios, if you have experienced severe symptoms of a particular illness prior to getting insurance but are afraid of the potential high medical cost you may incur because you lack a shield plan, and then you decide to proceed and get your own policy (and fail to truthfully declare your health during application). Subsequently, you see a doctor and get yourself hospitalized, the hospital pass all the available information to the insurer including the (possible) fact that your symptoms are so serious it is impossible that you are not aware of, and that judging from the severity, it could have been dragged for months before you seek medical attention.
Should the insurer just proceed to approve your claims because you think claims should be guaranteed?
Should the insurer just decline your claim directly because doctors are more professional than you?
Would it better if the insurer give you the benefit of doubt and tries to clarify the information with you directly?

There is really no point arguing over assumptions (especially yours) since the possibility is limitless.

To have meaningful discussion, at the very least present a case with full details (and not a biased, one-sided story).

Lastly, it seems like you haven't realized, what you are doing is no different from an unethical agent who goes around fearmongering. Just that you are on the opposite side.

 

[dendii]

Well agents are the people that helps to resolve all these and facilities the process. You said to skip the consumers as the middleman. Isnt that what agents are for? You are suppose to be resting while we are helping you chase, update results of claims.

If you encounter an issue with any company, you call the customer service or department that handles customer complaints right?

I mentioned many times, we are the "Account Managers" so if you have any issue, you can direct it to us agents so that we can help to resolve it internally through the process in place.

Our clients bought their insurance from us, and we are suppose to be responsible to handle the sales and servicing for our clients.

If you want to play with my words I have no choice also

The hosp liase straight with the insurers so both parties know what they want, instead of gg through the consumer as middleman and ding dong here and there

funny there is no mention of agent's part in your comment