Tan Kin Lian's Blog: Rejected claim under Private Shield Plan

Sunday, October 10, 2010

Rejected claim under Private Shield Plan

Read the case study of a retiree who was badly advised by the insurance agent to upgrade to a Private Shield plan. He went for treatment and chose a private ward, thinking that the Shield plan would cover the higher cost. After incurring $7,000 in medical bills, the claim was rejected as the insurance company said that he did not declare his diabetic condition. He was not aware that he was suffering from diabetes, and his doctor did not advised him to take medication.

If he had gone to B2, the bill for the survey (not connected to diabetes) would have been much lower and would be covered by basic Medishield.

Read the case study in www.tankinlian.com/ask.aspx (search for "rejected claim")

Advice: Do not upgrade to Private Shield when you are old. There will be medical conditions that you are not aware of, which will cause the claim to be rejected for non-disclosure.

Read my FAQ on "Medishield and Private Shield" to find out the difference in medical bills, government subsidy, coverage under the Shield plan and the co-payment that has to be paid by you..

2 comments:

Spur said...: That's why when it comes to medical conditions, exclusions, waiting period etc etc, it's very difficult to win against the insurers once you explicitly sign your "acceptance" and "understanding" of the contract. Fidrec will be hard pressed to rule in your favour, even if you show that you totally are not aware of any pre-existing condition, and have all along feel totally fine, take part in rigorous sports etc. The insurer will have covered their bases with statements, casefiles and opinions from their panel of specialists together with your hospital's cooperation! And the actions by the insurer is fully according to contract law as signed & accepted by you. Even if you engage your own lawyer & specialist, at the end of the day it is still your specialist's opinion against the insurer's specialists.

I was in the G&H dept of a major local insurance company for 2 years. During those 2 years, I was involved in 10 cases of rejected Shield claims due to pre-existing medical conditions. I think 4 or 5 went to Fidrec. None won against the insurer. According to my other older colleagues, for pre-existing cases, less than 1% will win at Fidrec. Maybe it's different for cases involving investments, endowments, savings etc but with medical cases, very tough for customers to win their case. So much so that my G&H colleagues can even tell off unhappy customers over the phone to "go to Fidrec if you're not satisfied".; October 10, 2010 7:26 PM
yujuan said...: There is totally no consumer protection in Singapore, as we are still a Third World country.
Not all things that glitter is Gold. Singapore only glitters on the surface, underneath there is no Gold.
Maybe we should all revert to plain vanilla Medishield, but would CPF accept us back? The Board seems unwilling to take on the responsibility.; October 11, 2010 2:20 PM