Tuesday, January 15, 2013

Be careful about upgrading to a Private Shield


14 January 2013

Editor, Forum Page
Straits Times

I have received several requests for assistance from elderly consumers
who had upgraded from the basic Medishield cover to an integrated
Shield policy offered by an insurance company and have their 
subsequent claims rejected.

The main reason for rejection is the alleged non-disclosure of 
pre-existing illnesses at the time of upgrading. In many cases, the
medical record came from the polyclinic that were treating the 
consumer. The consumer might not aware about the medical 
condition as they did not understand what the doctor had told them.
Some of these treatment had happened many years earlier.

Many consumers were not aware of this risk of non-disclosure, as they were 
not properly explained of this requirement by the insurance agent. 

They were also told that the private Shield policy provide better 
coverage. This is not true in the case of an elderly patient who was willing to be
treated in a subsidized B2 and C class ward. The Private Shield plan require them 
to pay a significantly higher premium without getting any tangible benefit. Instead, 
they have to suffer the trauma of getting their claim rejected. 

I suggest that it should be the duty of the insurance company to 
check for existing medical conditions at the time of accepting the
upgrading, rather than at the time of a claim. They can ask the 
consumer to declare the doctor that they have been seeing regularly.

Even if the insurance company had to reject the claim under the 
upgraded cover, they should at least assist the consumer to make a
claim under Medishield, instead of leaving the consumer in the lurch.

Tan Kin Lian
President
Financial Services Consumer Association

4 comments:

zhummmeng said...

There are many cases of twisting by greedy and unethical insurance agents and in these the agents didn't warn the customers of full disclosure of existing condition resulting in loss of coverage.
MAS should take punitive action against these agents because it is serious enough to revoke these agents' license . They are menace to the public.

Miko said...

Hi Mr.Tan

1. I m currently covered by Medisave-appropved Private Integrated Shield? So it means I m considered opt-out from Medishield?

2. After I read your article, I checked with my insurance agent if I can still claim my hospitalized bill from Medishiled in the event if the private insurer rejects my claim.

His reply to me is : In fact, the insurer will submit the claim to MediShield for approval, if MediShield rejects it, the insurer will also reject it.

So, I m a bit confused now??

Kin Lian Tan said...

I think that agent gave you the wrong answer, or you understood it wrongly. I have no comments when the facts are confusing.

Janay Stiles said...

For people to have their claims rejected when they needed it the most never does look good. The best way for everyone to ensure their coverage is to read and fully comprehend their signed contract. This will let them know the scope of their coverage, which means they will know when to react or ask for help.
Janay Stiles

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