Claims return rates for Integrated Shield Plans

[akwl88]

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.

if fail to declare even though the agent has alr inform clearly during the prospect, of course is the patient's fault

i stress the word clearly

personal exp, have to get medical report personally from hosp (own expense) for insurer which i feel is a waste of time and very inefficient

fear monger simi?

i gain nothing from fear mongering. agents on the otherwise....

 

[akwl88]

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

prob is what you said are just words and words are cheap

There is no official and legal obligations for agents to service their clients. This is done out of "goodwill"

call liao, feedback liao or complain liao can get premiums refunds?

best is to make aware to the whole world so that pple know which agents are the scammers and which agent is really in your best interest

simply put, agents' wall of shame

 

[dendii]

No doubt about that.

Every industry have their fair share of black sheeps or scums if you prefer the term.

And i completely agree with you. Those agents not doing their job and being responsible to their clients are indeed scums.

I dont blame you for having the perception because majority of agents are probably not doing a right thing.

But dont discriminate insurance just because of it. There is a reason why people get insurance and fact is, it has helped more people than those who have had a bad experience.

Again, there is no 1 size fits all strategy because by nature, different people have different opinions and needs.

prob is what you said are just words and words are cheap

There is no official and legal obligations for agents to service their clients. This is done out of "goodwill"

call liao, feedback liao or complain liao can get premiums refunds?

best is to make aware to the whole world so that pple know which agents are the scammers and which agent is really in your best interest

simply put, agents' wall of shame

 

[akwl88]

No doubt about that.

Every industry have their fair share of black sheeps or scums if you prefer the term.

And i completely agree with you. Those agents not doing their job and being responsible to their clients are indeed scums.

I dont blame you for having the perception because majority of agents are probably not doing a right thing.

But dont discriminate insurance just because of it. There is a reason why people get insurance and fact is, it has helped more people than those who have had a bad experience.

Again, there is no 1 size fits all strategy because by nature, different people have different opinions and needs.

i dont discriminate insurance

i know the impt of insurance for protection

term + hosp is what everyone shld get

the rest is.......

 

[dendii]

Like i said, there is no 1 size fits all strategy.

But there are obvious plans that you can avoid like ILPs and Saving Plans for example.

Saving Plans still has a market though because there are still people who just spend whatever they earn.

From my experience, mostly females.

i dont discriminate insurance

i know the impt of insurance for protection

term + hosp is what everyone shld get

the rest is.......

 

[akwl88]

Like i said, there is no 1 size fits all strategy.

But there are obvious plans that you can avoid like ILPs and Saving Plans for example.

Saving Plans still has a market though because there are still people who just spend whatever they earn.

From my experience, mostly females.

i would term it as "delayed savings plan"

if a person just spend whatever they earn, what makes you think they can save the lump sum at maturity still instead of blowing all in one shot or surrendering the plan early at loss once they accumulate a certain sum?

if intention is to lock up the money to prevent pple from spending, have to compare with cpf rate

a good saving plan shld have min 4% returns and above

 

[dendii]

Because they spend whatever they earn, more so they need that lump sum at the end whether due to retirement or whatever.

They may blow it at one shot sure, but at least they have that lump sum at the end to decide what they want to do.

Sure topping up your CPF is a good way as well. But unfortunately also, majority of Singaporeans uses their CPF for housing.

There are definitely better ways but it all boils down to the individual. Hence no 1 size fits all strategy.

Anyway, like I said, Saving Plan is only good for a specific group of people.

i would term it as "delayed savings plan"

if a person just spend whatever they earn, what makes you think they can save the lump sum at maturity still instead of blowing all in one shot or surrendering the plan early at loss once they accumulate a certain sum?

if intention is to lock up the money to prevent pple from spending, have to compare with cpf rate

a good saving plan shld have min 4% returns and above

 

[akwl88]

Because they spend whatever they earn, more so they need that lump sum at the end whether due to retirement or whatever.

They may blow it at one shot sure, but at least they have that lump sum at the end to decide what they want to do.

Sure topping up your CPF is a good way as well. But unfortunately also, majority of Singaporeans uses their CPF for housing.

There are definitely better ways but it all boils down to the individual. Hence no 1 size fits all strategy.

Anyway, like I said, Saving Plan is only good for a specific group of people.

Thats why i said delayed savings plan

Thats why top up cpf because mortgage deducted from OA and can get tax relieve too

Will not recommend delayed savings plan unless 4% and higher

 

[Bigoya]

personal exp, have to get medical report personally from hosp (own expense) for insurer which i feel is a waste of time and very inefficient

Are you even referring specifically to a hospitalization claim?

I have done PA claims before, the insurred had an accidental sprain on her wrist and she went to 3 follow ups medical appointment including 1 x-ray test. No hospitalization was required.
Firstly, the bills incurred for all 3 follow ups for the very same accident were fully claimable.
However, as she've went through an x-ray test, i personally think it is only reasonable for insurrer to ask her for the report to access the claim (or even it's simply just for show? SOP?)
Money wise, medical report is charged by the hospital, so please don't point arrow at the insurrer.
Time wise, should the insurer be given access to collect all your medical reports regardless of which hospital/clinics you go for your check ups? This could delay on the claims process (u will kbkp), this might easily lead to a PDPA breach (u will kbkp again).
And most of us are pretty much aware, govt hospital are famous for looooooong waiting time, including request of medical report. Should you be pointing arrow at the insurer again?

I have also done hospitalisation claim.
The insurered was warded for dengue fever and quite a handful of test were carried out. Being my 1st hospitalisation claim, I was honestly worried if there may be too much documentations to handle, and if the process could be complicated and I end up screwing things up. But I was later reassured, again, that the hospital will be directly liasing with the insurer for claims issues.
Within less than a month, the insured got her claims approved and
the only sweat I had was cold sweat from my panicking.
None of those medical reports I saw were required for me to submit to my company.

If you think any of these are troublesome and complicated, and you don't believe in having an agent to go through the hassle for you, don't even get insurance.
The more you claim the more you complain. You're better off not claiming.

 

[Bigoya]

Anyway guys, track derailed again.
Thread is on IPs claim rate for the love of everyone else camping in this thread.

 

[akwl88]

Are you even referring specifically to a hospitalization claim?

I have done PA claims before, the insurred had an accidental sprain on her wrist and she went to 3 follow ups medical appointment including 1 x-ray test. No hospitalization was required.
Firstly, the bills incurred for all 3 follow ups for the very same accident were fully claimable.
However, as she've went through an x-ray test, i personally think it is only reasonable for insurrer to ask her for the report to access the claim (or even it's simply just for show? SOP?)
Money wise, medical report is charged by the hospital, so please don't point arrow at the insurrer.
Time wise, should the insurer be given access to collect all your medical reports regardless of which hospital/clinics you go for your check ups? This could delay on the claims process (u will kbkp), this might easily lead to a PDPA breach (u will kbkp again).
And most of us are pretty much aware, govt hospital are famous for looooooong waiting time, including request of medical report. Should you be pointing arrow at the insurer again?

I have also done hospitalisation claim.
The insurered was warded for dengue fever and quite a handful of test were carried out. Being my 1st hospitalisation claim, I was honestly worried if there may be too much documentations to handle, and if the process could be complicated and I end up screwing things up. But I was later reassured, again, that the hospital will be directly liasing with the insurer for claims issues.
Within less than a month, the insured got her claims approved and
the only sweat I had was cold sweat from my panicking.
None of those medical reports I saw were required for me to submit to my company.

If you think any of these are troublesome and complicated, and you don't believe in having an agent to go through the hassle for you, don't even get insurance.
The more you claim the more you complain. You're better off not claiming.

Justifying your comms with a strawhat sentence telling ppl not to get insurance

Thats insurance agent for you

Back to topic

 

[Bigoya]

Justifying your comms with a strawhat sentence telling ppl not to get insurance

Thats insurance agent for you

Back to topic

Well nothing new i guess... regardless what I say (or agents say), it will always be another straw man argument in your ears.

Arguments with you can always go on forever, let's just stop at whatever that float your boat.

 

[Perisher]

Can't find the new table for 2016 and possibly for the coming 2017.
Looking specifically at the Claims return rates.
https://www.moh.gov.sg/content/moh_...s/comparison--of-integrated-shield-plans.html

No longer under the service indicators?
Or can someone direct me. Thanks.