28 December 2019
The local papers in Singapore reported that Surgery Patients would be able to get higher MediShield Life (MSL) payouts from 1 January 2020. This is because the Ministry of Health (MOH) has raised the MSL's claim limits. The papers have this similar table to show
Confusions
There have been a lot of confusions lately about how much MSL would pay for a medical claim. There were at least 2 Press complaints about the MSL's payout recently.
Many have the perception that they can get MSL to pay 90% of all the medical cost in hospitals They could also have the Government subsidies to defray some of the costs. In many cases, they would never expect the final bills of Public hospital to be higher than the Private hospitals. Some may or may not understand the "deductibles" but this was never a disputable cost item.
Mr. Seow Ban Yam is a 82-year-old Singaporean. He complained about the payout of $4.50 from MSL for his two cataract operations on his eyes. He did the operations at Singapore National Eye Centre (SNEC) in 2018. This $4.50 payout must be far from his expectation. He went to the Press, inviting active discussions in the local Forums. Quite sure Mr. Seow was not alone. There must be many other similar cases not reported to the Press.
Perception vs Reality
According to newspaper reports, Mr. Seow’s cataract surgery was around $12,000. His Government subsidy and "deductible" was about $10,500. Adding the cost of hospital stay of $205, the total payable left was around $1,500/=. Mr. Seow expected MSL to pay out $1,300/=. He was shock when he received a payment of only $4.50. These 2 tables must be what Mr. Seow expected and what MSL had worked out.
Mr. Seow expected
Item Description | Cost |
Surgery Cost | $11,831.00 |
Subsidy | $7,559.00 |
Sub Total | $4,272.00 |
Add Hospital Ward | $205.00 |
Sub Total | $4,477.00 |
Less Deductible Paid | $3,000.00 |
Total Payable | $1,477.00 |
Cost Sharings | Payment |
Patient 10% contribution | $147.70 |
CPF Life 90% | $1,329.30 |
MediShield Life worked out
Item Description | Cost |
Claim Limits | $2,800.00 |
Add Hospital Ward | $205.00 |
Sub Total | $3,005.00 |
Deductible Paid | $3,000.00 |
Total Payable | $5.00 |
Cost Sharings | Payment |
Patient 10% contribution | $0.50 |
CPF Life 90% | $4.50 |
The above tables assumed that the maximum claim limit of $1,400 has been used for the 2 operation done at the SNEC.
Claim Limit and Government Subsidies Workouts
MOH uses Claim Limits to make premiums affordable for everyone. It also ensure that there will be adequate coverage for almost every claim. MOH reviews the limits on a regular basis. The claim list has been expanded from time to time.
According to research materials, MOH used existing charges in Public and Private hospitals to work out the Limits. The charge covers about 50% to 75% of the patients. They sort out the Surgery Operation according to complexity to fit a Table of 7 shown earlier on in this article. The sorting work is shown in this “MOH’s Table of Surgical Procedures (TOSP)"
As for the Government Subsidies, they work out using this table released for Pioneer Generation Packages in 2014
Why Mr. Seow Ban Yam’s Surgery Cost so Much?
According to MOH, Mr. Seow’s Surgery Operation was complex. He’s surgery was one of 7 complex ones found among 42,000 surgery procedures. Mr.Seow’s surgery lasted for about 3 hours and he had this done on both eyes together at the same time.
How Much the Newer Limit would Help?
If Mr. Seow had the benefit of the new claim limits, he would have been $1,400/= richer. The amended work out is as shown in the following table
Item Description | Cost |
Claim Limits | $4,360.00 |
Add Hospital Ward | $205.00 |
Sub Total | $4,565.00 |
Deductible Paid | $3,000.00 |
Total Payable | $1,565.00 |
Cost Sharings | Payment |
Patient 10% contribution | $156.50 |
CPF Life 90% | $1,408.50 |
How to avoid “Mr. Seow's Problem"?
1. Never assume that MSL will pay the full medical operation cost. MSL is not like any private insurance plans which have higher medical coverage and claims. The MSL will only pay up to the Claim Limits. The rest will have to come from patient’s pocket or their MediSave;
2. Always ask how much the medical operation would cost. What one would expect to pay after the subsidy and other cost such as deductible;
3. There are approved procedures to qualify for Government subsidy. Choosing a particular doctor or asking for special treatments will be disqualified;
4. Read carefully any document that you must sign as such document must be important, often related to the medical charges;
5. Hospitals will always brief patients when there is a surgery operation. Besides the precautionary procedures to take, they will tell you the estimated cost of the operation. Take the opportunity to ask as many questions as you can including how they arrived the estimated cost.
6. Always check with friends and relatives who have done similar operations. Get them to advice you how to go about having the operation done. Also ask how much they have paid for the operation.
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