Monday, 27 May 2019

Story of elderly’s minuscule MediShield Life payout raise questions about Singapore’s healthcare system – The Online Citizen

82-year-old Seow Ban Yam was in for a shock when he discovered that MediShield Life had only paid $4.50 out of his hospital bill after an optical-related surgery last year.

The Straits Times reported on Monday (31 Dec) that Mr Seow had gone to the Singapore National Eye Centre (SNEC), which is a SingHealth cluster, to undergo cataracts removal on both of his eyes. Prior to that, he was informed that a blockage to the flow of his tears needed to be cleared first.

Mr Seow, a retiree and a former entrepreneur who ran a business selling books to schools, could have been paying over $12,000 for his surgery fees without a subsidy from the government. His bill amounted to $4,477 as a result of the subsidy.

Prior to the payout, Mr Seow had to fork out the first $3000 from his Medisave account as a part of the annual amount deductible for seniors above 80 years of age.

While MediShield Life’s policy stipulates that the insurance will cover 90 per cent for the first $5000 of such subsidised fees, and 97 per cent for bills above $10,000 in total in a single insurance year, MediShield Life reportedly only paid $4.50 in Mr Seow’s case.

A Ministry of Health (MOH) spokesperson – in commenting on the seemingly disproportionate reimbursement, in relation to what Mr Seow had initially paid – said: “MediShield Life claim limits have been sized to cover nine in 10 of subsidised bills to balance between providing assurance to patients and ensuring affordability of premiums.”

“As the national referral and tertiary eye centre, SNEC’s cost and fee structures are higher than those at other public healthcare institutions,” the spokesperson added.

SNEC has “cost and fee structures (that) are higher than those at other public healthcare institutions”: SNEC CFO

While SNEC billed Mr Seow $4,272 for the operation, MediShield Life’s coverage of the specific procedure has a cap of $2,800.

In addition to the surgery, the insurance also covered the cost of his one-night stay and “consumables” which amounted to $205.

Considering MediShield Life only paid $4.50, Mr Seow had to foot the remaining amount of $1,472.

The maximum reimbursable amount, according to the Central Provident Fund, was $3,005.

“The whole idea of MediShield Life is to meet heavy bills. I don’t understand why it is limited to $2,800 when the bill is more than $4,000.

“This defeats the purpose of insurance,” lamented Mr Seow.

However, the MOH spokesperson said: “The amount not covered under MediShield Life can be paid using Medisave. Patients who face difficulties affording their bills can apply for Medifund.”

Medifund could not be applicable to Mr Seow, as he was able to pay the bill with his Medisave money.

Chief financial officer of the SNEC Ms Irene Png explained told ST that SNEC has “cost and fee structures (that) are higher than those at other public healthcare institutions”. 

“The three-hour operation was done in the major operating theatre and was followed by post-operative monitoring and care. The higher fees charged were for the complex tertiary care that Mr Seow received,” she added.

Earlier, the MOH spokesperson said: “MOH will continue to work with SNEC on funding and review its costs and charges to improve patient affo