Integrated Shield Plan Lesson Learnt

[Mr. Wood]

U mean "loading" (and not "rider") right"?

Loading is you pay extra, due to sub-standard case.

Rider is when you pay extra, to get covered for additional claim scenarios.

yes. loading not rider.

 

[Mr. Wood]

**** insurance and gamen taking easy way out - raise premiums punish ordinary ppl.
whereas the real issue are the doctors and patients in cahoots to play the system.
dare to punish ordinary ppl but dun dare to touch elites and rich ppl. ****rs

 

[soneat]

yes. loading not rider.

Just take it as a lesson learnt.

The idea here is if you are convinced that the "condition" is nothing serious, do not accept the loading. Try applying with another company at another time with an agent who is more savvy and willing to help you.

By default, typical agents will tell us we are "lucky" that the company is still willing to underwrite despite having a "condition" - and thus we should quickly accept (the loading) and move on.

 

[a4973]

Does anyone know if the insurers do mix the risk and premiums of pte and public hospital plans? Or are they segregated?

 

[clumsycat]

Tks guys for sharing xperiences and advices. I think I go find 2nd opinion liao because now you all say like tat, maybe surgery really not necessary. Maybe recommended to earn money and tt's y insurer buay song. I guess this is also another lesson to learn.

 

[OngHuatHuat]

I personally think that now all insurers are trying their best to make private claims difficult so that those private doctors won’t charge a very high fees for unnecessary surgical procedures.

If not the medical insurance fees will be driven up to a unsustainable level such that not many people willing to subscribe.

Tks guys for sharing xperiences and advices. I think I go find 2nd opinion liao because now you all say like tat, maybe surgery really not necessary. Maybe recommended to earn money and tt's y insurer buay song. I guess this is also another lesson to learn.

 

[BiomedicalPasta]

Got a question. I buy IP very long liao, more than 10 yrs. But past 2 3 yrs got gastro problem, did a scan and scope all clear, just some mild inflammation. In future if sway kerna something bad in the gastro system, still can claim? I have no plans to switch insurer at all.

 

[Mecisteus]

Tks guys for sharing xperiences and advices. I think I go find 2nd opinion liao because now you all say like tat, maybe surgery really not necessary. Maybe recommended to earn money and tt's y insurer buay song. I guess this is also another lesson to learn.

If cannot claim, then of course it makes sense to get a 2nd or 3rd opinions.

If can claim, don't need to think so much.

 

[Discarded]

Tks guys for sharing xperiences and advices. I think I go find 2nd opinion liao because now you all say like tat, maybe surgery really not necessary. Maybe recommended to earn money and tt's y insurer buay song. I guess this is also another lesson to learn.

Which sore throat needs surgery one? What illness is that?

If I am the insurer, someone bought insurance 1 month ago, 1 month later need surgery for throat. I will be suspicious that he didn't declare too.

Chronic illness that require surgery usually don't occur immediately.

 

[Discarded]

Got a question. I buy IP very long liao, more than 10 yrs. But past 2 3 yrs got gastro problem, did a scan and scope all clear, just some mild inflammation. In future if sway kerna something bad in the gastro system, still can claim? I have no plans to switch insurer at all.

Some people say kum gong, but the other way is to do a full body checkup? Those premium $500 one. Whatever is checked is there. Illness declared.

 

[pohw0008]

This kind of things is why i rather go gov hospital.. at least wont tio prawn..

 

[Mecisteus]

This kind of things is why i rather go gov hospital.. at least wont tio prawn..

This is nothing to do with getting pawned.

It depends on your coverage.

If you have a as charge and private ISP, why would you go for a gov hospital?

If you go to a buffet, I am sure you want to eat everything that you can.

 

[ALZW94]

This is nothing to do with getting pawned.

It depends on your coverage.

If you have a as charge and private ISP, why would you go for a gov hospital?

If you go to a buffet, I am sure you want to eat everything that you can.

Maybe the ISP reject claim how?

 

[BBCWatcher]

Maybe the ISP reject claim how?

Possible. That’d happen in these scenarios (examples):

1. The procedure is medically unnecessary or cosmetic in nature. Integrated Shield plans only cover medically necessary care.

2. The care relates to a preexisting condition. In that event you’re only covered to MediShield Life limits.

3. The procedure itself is covered, but the related care continues beyond the coverage window. This is more likely to occur if there are complications, and complications can occur with surgery or any other invasive procedure. The risk of complications must always be weighed against the expected benefits. There is no Integrated Shield carrier that offers a post-hospitalization coverage window longer than 13 months, and there are some that are quite a bit shorter.

4. It’s fairly far fetched, but hypothetically it’s possible for an unlicensed quack to be practicing medicine. Whatever the quack does to you isn’t covered.

5. You blow through your plan’s annual limit. That’s more likely to happen if you obtain questionable, expensive medical care then genuinely need expensive medical care (such as complicated surgery, a prolonged ICU stay, and expensive medications) within the same policy year.

6. There’s some form of fraud involved, such as a kickback you’re getting from the medical provider.

In short, with or without insurance coverage, you should still be a sensible, reasonable medical consumer.

 

[daewood]

Nowadays no more ethical already

Sent from OnePlus ONEPLUS A5010 using GAGT

 

[qhong61]

Recently got letter of guarantee rejected by insurer.

Doc said I need surgery (throat problem), but insurer declined LOG. They asked me to pay first then try to claim. Quite worried. Bill not cheap. Agent said because I got sore throat before, claim might not be approved. But who never get flu or sore throat before? Last time told me small things like flu/cold no need to declare, then now suddenly my fault.

Nurse explained to me that this time it's a chronic condition. Old sore throats should not be part of this as they were resolved with medicine or just by resting. Those were acute sore throats, usually caused by flu bug or bacteria. I don't know why insurer doesn't see the diff, or is it they don't want to see the diff?

I understand maybe because my insurance is quite new, cannot claim 也就算了. But now insurer keeps asking questions! I scared they say I never declare sore throat before, then turn around and say I fraud sia.

Anyway, for those planning to buy shield plan, please declare ALL the illnesses you kena before, even if it's just flu, cough or even a baluku. Don't end up like me.

Very depressed. Doesn't help at all when I am struggling with a chronic infection. I don't want to name the insurer or any name, in case become big hooha they come and sue me. It will be a fight I can never win. The big corporations will always win. 小人物 like me always lose.

Anyway I just sharing my lesson learnt. If you have any experience with Integrated Shield Plans or lesson learnt, please also share to raise awareness. Thank you.

Actually u should declare.

 

[bobobob]

Recently got letter of guarantee rejected by insurer.

Doc said I need surgery (throat problem), but insurer declined LOG. They asked me to pay first then try to claim. Quite worried. Bill not cheap. Agent said because I got sore throat before, claim might not be approved. But who never get flu or sore throat before? Last time told me small things like flu/cold no need to declare, then now suddenly my fault.

Nurse explained to me that this time it's a chronic condition. Old sore throats should not be part of this as they were resolved with medicine or just by resting. Those were acute sore throats, usually caused by flu bug or bacteria. I don't know why insurer doesn't see the diff, or is it they don't want to see the diff?

I understand maybe because my insurance is quite new, cannot claim 也就算了. But now insurer keeps asking questions! I scared they say I never declare sore throat before, then turn around and say I fraud sia.

Anyway, for those planning to buy shield plan, please declare ALL the illnesses you kena before, even if it's just flu, cough or even a baluku. Don't end up like me.

Very depressed. Doesn't help at all when I am struggling with a chronic infection. I don't want to name the insurer or any name, in case become big hooha they come and sue me. It will be a fight I can never win. The big corporations will always win. 小人物 like me always lose.

Anyway I just sharing my lesson learnt. If you have any experience with Integrated Shield Plans or lesson learnt, please also share to raise awareness. Thank you.

Hi ts, it sounds like your health issue and the problem with the insurer is causing you a lot of distress, and you feel helpless, like you can't win if there is a dispute with the insurer.

I don't think it's true that you're helpless if the insurer isn't being fair to you. There is financial dispute mediating body called fidrec that can help you.

But I think the insurer is just trying to make sure you aren't trying to cheat them either. A lot of people sign on a policy only after they realise they have a medical issue. And they hide that info from the insurer when they are signing so they can get them to pay the bill.

If you didn't do that, then you've nothing to fear. And a Dr can help you verify that your condition was a recent development, and help you write a letter stating that to the insurer.

If you are getting another opinion then it's a good idea to go to a Dr that is on your insurers approved list. I think that makes the insurer more likely to trust them.

It is a tough spot to be in, having to deal with a health problem and now stress from the insurer, but I think there's many steps you can take to smoothen the process, and even if the insurer does unfairly reject your claim later down the road.

 

[greentiger]

If there is no such thing as private health insurance, a lot of private specialists will close shop.

 

[maumu]

wow, good timing to come across this thread. might be pondering if surgery is necessary for my current wrist injury... going to see specialist tomorrow. was also told by polyclinic doc (before being referred) that can maintain status quo but injury can take months to heal on its own.

if the spec says the same thing (surgery is to help quicken recovery) does it mean it will not be covered under insurance? do we need to check with insurer first before confirming with spec?

 

[BBCWatcher]

For what it’s worth, here’s Great Eastern’s definition of “Medically Necessary,” although this definition is typical or identical in other Integrated Shield plans:

Medically Necessary
Medically Necessary refers to treatments, medical services and/or supplies which are:
(a) pursuant to an order of a Medical Doctor;
(b) consistent with the diagnosis and customary medical treatment for a covered illness, disease or Injury, in accordance with generally accepted medical practice in Singapore;
(c) in accordance with the standards of good medical practice, consistent with current standard of professional medical care, and of proven medical benefits;
(d) not purely for the convenience of the Life Assured or the Medical Doctor, and unable to be reasonably rendered in an outpatient setting if admitted as an inpatient;
(e) not of an investigational or research nature (including but not limited to experimental, pioneering medical or surgical techniques and medical devices) not approved by the Institutional Review Board and the Centre of Medical Device Regulation or other relevant authority and medical trials for medicinal products whether or not these trials have a clinical trial certificate issued by the Health Sciences Authority of Singapore or other relevant authority; and
(f) not preventive, screening or health enhancement (including but not limited to dietary replacement or supplement) in purpose.

Elsewhere in the policy document Great Eastern lists several exclusions, including anything related to professional sports. For example, treatment for a wrist injury occurring in a professional tennis tournament wouldn’t be covered. (And some people wonder why Singapore hasn’t excelled in professional athletics. Add this insurance exclusion to the pile of reasons.)