Saturday, October 27, 2012

Claims snag after upgrade to IncomeShield

From James Wong Chee Wah (printed in Today paper)
Last December, I converted to the Enhanced IncomeShield basic plan after being insured under MediShield since the scheme was introduced.

This year, I was admitted thrice to hospital for heart problems. I decided to stay in the "C" Class ward, even though my insurance plan entitled me to a B2 ward, and incurred a total hospital bill of about S$12,000.

However, NTUC Income did not pay my claim on the grounds that I did not disclose that I had a cancerous kidney removed in 1992 and other conditions which were cured, even though there was no relapse for almost 20 years. The insurer also wanted to cancel my policy and refund my premium.

I understand that for the integrated plan as specified by the Health Ministry, my claims should be covered under the basic MediShield plan, which I had all along.

NTUC Income, though, sent me this statement: "You will remain insured under Basic MediShield if you satisfy the CPF's eligibility criteria."

What does this mean? Surely, it is the insurer's duty to check and then decide if I am eligible to be paid under Central Provident Fund coverage. After four months, my claims have not been settled, causing me stress.

I would advise others to avoid upgrading to an enhanced plan, as they, too, may have claims rejected on unfair grounds. Does the ministry have views on this matter?


Lye Khuen Way said...

About time the Authority do some smacking.

Dishonest conduct being condoned left , right & centre, no ?

What was meant to be part of the medical safety net here is proving to be just that. A net, full of holes.

After passing the buck to the ordinary man-in-street, we expect the govt to ensure that that safety net is real, not a fish net that cannot hold water.

zhummmeng said...

This is likely the fault of the greedy or incompetent insurance salesman who called themselves financial consultant. The salesman should have conducted a fact find and asked relevant questions to ensure no material information being left out for recommendation.
NTUC doesn't require their salesmen to conduct fact find on medical insurance which is a breach of LIA directive.
If the salesman conducted the fact find this is dispute would not have happened.
I heard ntuc is among the lowest of the insurance companies that require compulsory fact find.
The CEO talked a lot about his dreams for ntuc...only dream he has not dreamed is for his super salesmen to move to advisory roles.Only as advisers can these salesmen add values to their customers. Unfortunately they are adding commission to their pockets at the expense of the customers. This is the critical change ntuc must make otherwise it is just another sales orgainsation pushing products for profit.. Made different? no different from the rest , lah..

Johnny Kwa said...

Felix Ng · Top Commenter · University of Adelaide
This is alarming. If an insured pays for enhanced medishield, and decides to stay in the ward he/she deem "entitled", say Class A in private hospital. While there is no need for immediate payment upon discharge. However if the insurer decides not to pay the bill, the insured will need to come out with a huge amount of money.

A one day Class A bill in private hospital will easily cost up to $1000 per day depending on what conditions. A 10 days will cost $10,000 estimated. It definitely will wipe out a person's saving.

Even though the insured might have not disclosed further into some details or the agent did not write it down on the policy application form. The authority should make the insurance company honour their words, after X number of years once the policy is in place. They should not denying claims, after years of paying premiums, used the premium to generate profits, and return the premium to the insured without interests

Johnny Kwa said...

NTUC Income CEO aspires to be the most responsible insurer but I think he is either blowing hot air or does not know what the ground is doing!

yujuan said...

Yes, it's very alarming that insurers are allowed such ease to get away with not paying up.
Guess we have to fight for the patient stop being the sucker to pay up first, then try the tenuous way to get reimbursement from the insurer.
The insurer has all the time to try all devious means to avoid paying up.
Sickening thought, what are we buying insurance for.

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