Tan Kin Lian's Blog: Shield claim

Friday, June 25, 2010

Shield claim

Dear Mr Tan,

A few months back my father went to hospital to do a post-hostpitalisation treatment of immunotherapy for bladder cancer. He is insured under Enhanced IncomeShield Policy and NTUC said that as the date of treatment exceeds 90 days from the date of hospitalisation (it was 93 days) they are not liable to pay.In fact, we got the doctor to write a letter of appeal but it was rejected. Would you know how we can appeal for this?

REPLY
Please ask the insurance company to give you a written reply for their rejection, i.e. to quote the clause from the policy about the coverage and their reason for rejection.

I believe that the policy does cover outpatient treatment for cancer. Can you see if your father's condition fits into this outpatient treatment? It is not related to the 90 day period from post-hospitalisation. I am not familiar with the exact coverage, so my remarks needs to be checked against clarification from the insurance company.

13 comments:

Anonymous said...: That is something new and very shocking to me ! I have also bought Enhanced Income Shiled and is not aware that we are not able to claim if date of treatment exceed 90 days ! So how can insurance policies protect us ? We just simply pay and pay for nothing ?; June 25, 2010 9:43 AM
Anonymous said...: Imagine, exceed only 3 days. so technical..hor.and quiver over it..The insurer is always looking for slight loophole to avoid paying.; June 25, 2010 10:29 AM
Anonymous said...: Shocking!; June 25, 2010 10:43 AM
Anonymous said...: When Mr Tan was in charge, he had created a "claims committe" and they meet weekly to review cases of this nature, and based on the information provided, the claim will be approved as it is such a borderline case, ( Heart first bottomline second -that was how Mr Tan worked )

I have first hand knowledge, and I was not a manager but just an ordinary staff, who attended these meetings to present cases of this nature for another product.; June 25, 2010 11:12 AM
Anonymous said...: For most shield plans including EIS, there is a limit of 90 days for post-hospital followup treatment.

However, immunotherapy for cancer is claimable as outpatient treatment, so you should claim as such, and NOT as post-hospital treatment. Furthermore, outpatient treatment claim is not subject to deductible, so is better for you.

I am surprised that Ntuc staff did not advise you properly and simply just reject your claim. I am sure the staff are all trying to hit their KPIs of minimal claims in order to get extra 2 months performance bonus.

In US, UK or Oz you will be able to not only get your medical claim, but also get extra $$$ to compensate for wrongful advise and aggravations.; June 25, 2010 11:43 AM
Anonymous said...: 90 days post hospitalization is in the brochure and policy documents. For goodness sake, do not sign blindly when purchasing and later blame everybody but yourself for not reading the documents. When pointing a finger at others, there are 4 fingers pointing to self.; June 25, 2010 10:00 PM
Anonymous said...: Hello -10:00 PM,

I do hope that you are perfect in all your understakings, as your comment made will surely come back to haunt you for your ungracious attitude!!; June 25, 2010 11:56 PM
Anonymous said...: Perhaps on a lighter approach,speak to the press about your case and ask them to help.I am sure,NTUC Income will take up this matter and resolve amicably in the hope of gaining trust from Singaporean.

NTUC Income Policy Holder since 90s; June 26, 2010 12:36 AM
Anonymous said...: June 25, 2010 10:00 PM,
not everyone is like you, turn the forms upside dowm. The majority trust the agents that they are honest and will advise the customers what to do.
Just sign here and there and this exactly what the agents will instruct.
On the other hand the insurer should apply with compassion .; June 26, 2010 10:56 AM
Anonymous said...: Just for understanding:

1) Is immunotherapy covered under Medishield?

2) If the post-hospitalisation has a limit of 90 days, then by how many days can a patient exceed for claim?

3) If exceed by 3 days can claim, then will it be unfair to those who exceed by 4 days?

4) If there is unlimited to post-hospitalisation, is it a good thing?; June 27, 2010 1:44 AM
Anonymous said...: The point here is its not whether it has exceeded by 3 or 4 or 100 days, Income was set up for the people by the people, to provide a low cost 'social service', as such there are cases where 'hearthware' comes into play.
(Please, lets not argue that I am suggesting that they run at a lost, NO!); June 27, 2010 5:00 PM
Anonymous said...: Like that buy insurance for what? Just save your money & hide under your mattress.; June 28, 2010 4:37 PM
Anonymous said...: To Anonymous at June 25, 2010 11:43 AM, many thanks for your advices.

What you said is true and this was reflected at the company's webpages.

To be fair and to clear any misunderstanding, NTUC did cover for hospitalisation bills etc. What I mentioned is the category under "post hospitalisation treatment" and if you looked at other insurers, it will be similar at a max of 90 days.

The claim is small for NTUC who made $288m last year (ref. 2009 financial report).

Of course NTUC can be beauraucratic and reject the claim. It has the rights to do so under the terms and conditions.

However, I do like to point out the fact that common people like me who do not have good information on the insurance industry do get mixed up by all the medical jargons and insurance terms and conditions. That is when I would expect the insurance company to be fair and be able to provide good advices.; June 28, 2010 7:40 PM