Integrated Shield Plan Lesson Learnt

[maumu]

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:


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.)

thanks for your insights.

mine's just an injury from exercising... in the gym. seen the docs 3 times (polyclinic) over the past few months and healing progress has been very slow. guess it's also due to old(er) age...

feeling quite down because i dun wanna continue to feed on painkillers for long term.

sometimes i feel insurance in general is kinda scam-y. in the end, the conditions to claim is actually like only when you're somewhat dying or have a severe, unpredictable condition. i wonder if the money saved each year from not paying insurance could have just been enough to cover treatment/cost of recovery over the years. and rely on just basic govt plans like subsidised treatment, medishield, etc.

 

[bobobob]

thanks for your insights.

mine's just an injury from exercising... in the gym. seen the docs 3 times (polyclinic) over the past few months and healing progress has been very slow. guess it's also due to old(er) age...

feeling quite down because i dun wanna continue to feed on painkillers for long term.

sometimes i feel insurance in general is kinda scam-y. in the end, the conditions to claim is actually like only when you're somewhat dying or have a severe, unpredictable condition. i wonder if the money saved each year from not paying insurance could have just been enough to cover treatment/cost of recovery over the years. and rely on just basic govt plans like subsidised treatment, medishield, etc.

Are you getting the sense that surgery for your injury will not be covered by the insurer, based on those criteria? Because it sounds to me like it would.

It sounds like your injury isn't recovering on its own, so surgery at this point is necessary course of treatment.

 

[BBCWatcher]

It sounds like your injury isn't recovering on its own, so surgery at this point is necessary course of treatment.

Maybe. Surgery may or may not speed healing, and there's a risk of complications. Professional medical opinions help inform these decisions.

 

[Mecisteus]

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.

A wrist surgery is not important to me. You can stop doing weights and going to the gym but you can still do other form of exercises like running or cycling.

I would go for surgery if it is my knees. I don't mind paying for it but if I can claim then it is a bonus.

 

[twinbaby]

Hi Clumsycat,

I had a sore throat for many years mostly viral infection. The tonsil has already existed for many years when I was born before I brought my shield plan. I have also brought a shield plan with the rider without any exclusion. But my sore throat first time I saw pus oozing out and got multiple lymph nodes on the neck. So far I am seeing a private specialist and even got a blood test done. I am concern whether I will face the same problem as yours if I were to opt for elective tonsillectomy surgery.

 

[dgeralds]

Even if you don't smoke, declare as occasional smoker

Even if you don't drink, declare as occasional drinker..

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.

 

[Squaredot]

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.

I go to SGH tho I have private hospital coverage with rider. I bought private hospital coverage for backup, in case I need a better doctor at private hospital or a good gov doctor go private when I need their service.

And NO, I don't eat everything at any buffet and I don't over eat. Don't like the big full tummy feeling. When I go buffet is for the wider choice of food, at small amount.

 

[a4973]

I go to SGH tho I have private hospital coverage with rider. I bought private hospital coverage for backup, in case I need a better doctor at private hospital or a good gov doctor go private when I need their service.

And NO, I don't eat everything at any buffet and I don't over eat. Don't like the big full tummy feeling. When I go buffet is for the wider choice of food, at small amount.

Doesn't govt hospital plan cover govt hospital even under private patient status?

 

[BBCWatcher]

Doesn't govt hospital plan cover govt hospital even under private patient status?

Yes, at least to some degree. In fact, an Integrated Shield plan designed to cover public hospital care will also cover a certain percentage of private hospital care.

 

[blurpandasg2014]

Sharing a true case that happened very recently. I have a Fren who bought coverage with 'A' company. Very unfortunate in her case

Applied for ISP with rider in late Oct 2019. In early Nov 2019,was walking down a slope,felt sudden sharp pain and instability in her knee. Couldn't walk... Made her way to TTSH A&E, xray done, no broken bones, sent home and referred to specialist in Jan 2020.

'A' plan was only incepted in late Nov due to some administrative issues. Did not inform insurer as A&E did not diagnose anything sinister

Fast forward to Jan 2020, specialist did MRI, said that ligament torn but since she was young, there was no big issue. Recommended physio. Pain did not get better. Only in Nov 2020, TTSH specialist recommended surgery. Seeked 2nd opinion at private and they too agreed that surgery was the only way

'A' company rejected her LOG stating that she did not declare pre existing. As a layman, who would have known that this sudden knee pain would lead to surgery... And if not medically trained, who knows wtf is a torn ligament and how serious it can be.

The agent in charge did not help appeal and she had to do all the appealing on her own despite having just gone through surgery. 'A' company sent her a revise document with exclusion and refused to pay for anything related to that knee in future


Moral of story... Sign your plan early. Declare everything... Especially this grey zone, while waiting for application approval

 

[proton_cannon]

Sharing a true case that happened very recently. I have a Fren who bought coverage with 'A' company. Very unfortunate in her case

Applied for ISP with rider in late Oct 2019. In early Nov 2019,was walking down a slope,felt sudden sharp pain and instability in her knee. Couldn't walk... Made her way to TTSH A&E, xray done, no broken bones, sent home and referred to specialist in Jan 2020.

'A' plan was only incepted in late Nov due to some administrative issues. Did not inform insurer as A&E did not diagnose anything sinister

Fast forward to Jan 2020, specialist did MRI, said that ligament torn but since she was young, there was no big issue. Recommended physio. Pain did not get better. Only in Nov 2020, TTSH specialist recommended surgery. Seeked 2nd opinion at private and they too agreed that surgery was the only way

'A' company rejected her LOG stating that she did not declare pre existing. As a layman, who would have known that this sudden knee pain would lead to surgery... And if not medically trained, who knows wtf is a torn ligament and how serious it can be.

The agent in charge did not help appeal and she had to do all the appealing on her own despite having just gone through surgery. 'A' company sent her a revise document with exclusion and refused to pay for anything related to that knee in future


Moral of story... Sign your plan early. Declare everything... Especially this grey zone, while waiting for application approval

All insurers nowadays getting more strict in claims. They are for-profit, and the gov has close eyes on how they rejecting the claims already to keep the integrated plans profitable.

Likewise, Early CI plans are also seemingly seeing a larger amount of claims rejection. Unfortunately, PAP gov did not mandate insurers companies to be more transparent in forcing data to be made public over the net on demand like what UK does.

 

[firsttimebuyer]

I guess I just count myself unlucky for getting sick shortly after buying the plan. Like dexboi said, maybe it was brewing in me all along, but I really had no idea. All was well before I signed up.

Another learning point: make sure you are very confident that you won't fall sick within one or two years of getting insurance. Otherwise, very hard to claim and worse still, you will get questioned like a fugitive.

My insurer keeps asking questions, very scary. They want to access all my medical records, even those from long ago. I think they want to cancel me. If so, can I get insured again? I seriously have no known illnesses, like HBP, heart disease, diabetes, cancer all don't have. Or am I doomed? If I had known earlier, I wouldn't even apply for claim sia. Now get treated machiam criminal.

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.

Can I ask how is your case now?

I am now dealing with my insurer and it is quite frustrating; I don't actually know what I need to declare or don't need to declare, because the Insurance company's guidance is very unclear, even after emailing them:

1) I feel headache and went to see a GP during poly; some more than 20 years ago, need to declare?

2) I got diarrhea and went to polyclinic. need to declare?

 

[reddevil0728]

Can I ask how is your case now?

I am now dealing with my insurer and it is quite frustrating; I don't actually know what I need to declare or don't need to declare, because the Insurance company's guidance is very unclear, even after emailing them:

1) I feel headache and went to see a GP during poly; some more than 20 years ago, need to declare?

2) I got diarrhea and went to polyclinic. need to declare?

Maybe don’t need to dig threads to ask?

can pm?

anyway this person last seen 2020

 

[firsttimebuyer]

Sharing a true case that happened very recently. I have a Fren who bought coverage with 'A' company. Very unfortunate in her case

Applied for ISP with rider in late Oct 2019. In early Nov 2019,was walking down a slope,felt sudden sharp pain and instability in her knee. Couldn't walk... Made her way to TTSH A&E, xray done, no broken bones, sent home and referred to specialist in Jan 2020.

'A' plan was only incepted in late Nov due to some administrative issues. Did not inform insurer as A&E did not diagnose anything sinister

Fast forward to Jan 2020, specialist did MRI, said that ligament torn but since she was young, there was no big issue. Recommended physio. Pain did not get better. Only in Nov 2020, TTSH specialist recommended surgery. Seeked 2nd opinion at private and they too agreed that surgery was the only way

'A' company rejected her LOG stating that she did not declare pre existing. As a layman, who would have known that this sudden knee pain would lead to surgery... And if not medically trained, who knows wtf is a torn ligament and how serious it can be.

The agent in charge did not help appeal and she had to do all the appealing on her own despite having just gone through surgery. 'A' company sent her a revise document with exclusion and refused to pay for anything related to that knee in future


Moral of story... Sign your plan early. Declare everything... Especially this grey zone, while waiting for application approval

how was your friend's case?

 

[firsttimebuyer]

Sharing a true case that happened very recently. I have a Fren who bought coverage with 'A' company. Very unfortunate in her case

Applied for ISP with rider in late Oct 2019. In early Nov 2019,was walking down a slope,felt sudden sharp pain and instability in her knee. Couldn't walk... Made her way to TTSH A&E, xray done, no broken bones, sent home and referred to specialist in Jan 2020.

'A' plan was only incepted in late Nov due to some administrative issues. Did not inform insurer as A&E did not diagnose anything sinister

Fast forward to Jan 2020, specialist did MRI, said that ligament torn but since she was young, there was no big issue. Recommended physio. Pain did not get better. Only in Nov 2020, TTSH specialist recommended surgery. Seeked 2nd opinion at private and they too agreed that surgery was the only way

'A' company rejected her LOG stating that she did not declare pre existing. As a layman, who would have known that this sudden knee pain would lead to surgery... And if not medically trained, who knows wtf is a torn ligament and how serious it can be.

The agent in charge did not help appeal and she had to do all the appealing on her own despite having just gone through surgery. 'A' company sent her a revise document with exclusion and refused to pay for anything related to that knee in future


Moral of story... Sign your plan early. Declare everything... Especially this grey zone, while waiting for application approval

This is crazy, how is a torn ligament a medical condition?

 

[reddevil0728]

This is crazy, how is a torn ligament a medical condition?

Why is torn ligament not a medical condition?

it’s not normal. It’s injury what

 

[blurpandasg2014]

This is crazy, how is a torn ligament a medical condition?

To the insurer it’s a medical issue and they will not cover anything related to the knee.

 

[qhong61]

This is crazy, how is a torn ligament a medical condition?

Then what is it

 

[blurpandasg2014]

how was your friend's case?

She used company insurance for her surgery. Cancelled her AXA insurance and shifted to GE since both had the exclusion

 

[BBCWatcher]

She used company insurance for her surgery.

Which she probably should've done anyway (claim from employer-provided insurance first), but that's "water under the bridge."

She still has MediShield Life coverage for the preexisting condition, and that works fairly well for a Singaporean citizen obtaining subsidized care from the public medical sector.

Cancelled her AXA insurance and shifted to GE since both had the exclusion

The switch to Great Eastern shifted the preexisting conditions line that much farther into the future. I understand her frustration, but that's like cutting off a toe after AXA cut off a knee (metaphorically speaking). Also "water under the bridge" now.