stumped by low medishield payout

the following letter is published in the forum page in today's edition of the straits times:

Mar 7, 2011
Stumped by low MediShield payout

MY FATHER was hospitalised thrice in January - once at the Singapore General Hospital and twice at the National University Hospital (NUH).

When we received the bill for his first stay at NUH, I was surprised to note that though his payable amount was $2,300 - after a government subsidy for staying in C class - his MediShield claim was only $450.

I understand that there is a deductible of $1,000 and co-insurance of 20 per cent but even then, it does not work out to the $450 paid by MediShield.

The second bill came soon after and it was $2,200. Since we had paid a deductible, which was applicable for one calendar year, I expected the MediShield payout to be higher. But it was only $900.

I called the NUH billing department about it but they had no clue and advised me to call the Central Provident Fund (CPF) Board, which told me the amount to be calculated for the MediShield claim was not the full $2,300 submitted by NUH, but a sum after 'pro-ration', which came to $1,500.

I asked what this 'pro-ration' was and I was told it was calculated through means testing and for further details, I should call NUH.

I called the NUH patient service department and was told they would check with the CPF Board and get back to me. But, till now, no one has responded.

Who should I call now?

I wish such matters could be made more simple and transparent. A check on both the CPF Board and Ministry of Health websites has left me none the wiser.

Goh Poh Kheng (Ms)

my comments:

yes, it can be clearly puzzling from the writer's experience to find out that the 'maths' does not add up in terms of what is the actual payout by medishield after working out the deductible and co-insurance. but throw in the 'pro-ration' factor and the claimable amount came in even lower than expected. and the cpf board's answer to this is the calculation was derived through means testing and ms goh was told to call nuh. she did so and was told they would check with the cpf board and revert to her.

which leads us to her letter for which no further answers have been shed (so far).

i can understand her situation as many of my clientele who are on aviva myshield and myshield plus option a (without the option b rider covering the deductible) can be said to be 'clueless' when it comes to actual claims. but here, the 'maths' is more straigtforward as all of the myshield plans come with 'as-charged' benefits and the only unclaimable portion should be the deductible as the myshield plus option b rider has not been taken up.

even though the deductible is usually capped at the maximim of $3,000.00*, there has been a lot of unhppiness with the claims' experience of my clientele who clearly cannot and probably will not remember that the deductible portion will not be reimbursed to them, as they have not taken up the myshield plus option b rider.

*annual deductible will be increased by 50% for any insured person above 80 years old at age next birthday.

my delimma may be somewhat similar to ms goh because on the one hand, my advice is clear to my clientele and in their interests and yet, i'm always at the receiving end of what i believe to be unjustified venting and frustrations of my clientele on me.

sigh, am i in the wrong business?