Saturday, October 10, 2009

Pitfalls of Private Medical Insurance....

"To our surprise we found out that most families who were bankrupted by medical bills actually have medical insurance...."
- Professor Elizabeth Warren on US healthcare insurance.

So you think you're financially okay when you're sick because you bought medical insurance. What can be more straightforward, say you hurt your ankle, go to hospital and get it fixed then make an insurance claim to get paid. An ankle injury is relatively simple medical problem so you would think that making a claim would be simple - this is after all not America where insurance companies are known to routinely use the fine print on policies to deny claims and maximise profits. So that is what you think....
I gather from the above letter to the ST Forum on 10 Oct 2009 that the insurance company has categorised the cost of hospitalisation into 4 categories and each category has a limit. The hospital prepared the bill with nine categories and some of the expenses went to categories which are not reimbursed. At the end of the day, the man received $128 in reimbursements on a bill of $5900. Maybe this is an isolated incident but we don't really know. Private insurance companies are out to make money and when they sell you the insurance using marketing brochures, they give you the impression that you will be financially taken care of if you need medical treatment. The truth is private insurance make more money if the take the effort to reduce or deny claims. There is nothing in Singapore to stop our insurance companies from behaving the same way they do in America....in fact a number of these companies are from America and one of them even has America as part of its name. Actually things might be worse here given we have a govt that excuses itself and shouts "caveat emptor" at the 1st sign of trouble and a consumer association that has no teeth especially against big insurance companies.

I leave you with this clip from SICKO. Something to think about.

29 comments:

Anonymous said...

I always feel that so many people buy medical insurance, but only a small % of them get to use it.

And out of this small %, only a small % of them really able to claim their bills while a lot of them are not covered, at least not as much as what they think.

So not many people will actually get to know that what they buy is not what they think. Yet they are still paying for premium monthly or yearly.

Anonymous said...

Most people receive their insurance contracts after paying the premium, and most people don't bother to take a second look after receiving the documents. When it comes to payment, they realize that they have been misled or shortchanged.

I am one of such suckers. Investment products promised "non-guaranteed" returns, that means they set a cap for your investment return, but there is no floor for them to pay you the lowest other than the principle amount.

I believe that is the common experience of buyers of other insurance products.

Anonymous said...

the truth is you ask yourself this question:

if u have at least $10 million in your bank account, your sons and daughters studying in prestigious universities using TAX PAYERS money, your wife happily shopping away at orchard road ---> would YOU really care enough about those not able to pay medical costs?

So what is new? You die is your business; if you are not talented enough in singapore too bad because life will kick you in the balls.

The truth hurts doesn't it?

Now pay me my million dollar salary!

Are you jealous?

I know what the problem is...its the politics of envy!

tell me what is the role of the government again?

A Lost Singapore Citizen

Anonymous said...

That's the reason why I don't have any insurance policies. A friend of mine got breast cancer and did not manage to claim a cent.

I have been to America where I'm told a visit to the doctor for a cut can cost like $1000. I think we're going the way with the government shriking its responibilities and passing the cost to the patient.

I say we vote out the present government and revamp the system. Their multi-million salary can fund a lot of healthcare for the old and needy.

Anonymous said...

The problem is healthcare and insurance are competing with each other to see who gets more out of the insured should he or she lands in hospital.

Any increase in claims is met by an increase in coverage and likewise an increase in premiums. The hospitals knows this and will not hestitate to increase their charges. What to do? Can die, but don't fall sick!

Anonymous said...

anon 15:56,

you are smart, not many singaporeans know about this haha!

the fact is hospitals and insurance companies squeeze the sick people (i work in an insurance company)

Next time when you visit hospitals, take a look at all the cars that the doctors drive. But don't get jealous because the doctors work hard for it.

Singaporeans pls don't feel bad for the sick because we are the true capitalist. Only the rich Singaporeans will survive and deserve the best in life.

Americans and europeans are just whinny capitalist aka closet socialist.Even, US has food stamps and welfare for single parents!!!OMG how weak can they be? Welfare should be a global DIRTY word in the same league as F*CK

MONEY has NO compassion.

Singaporeans can die but don't get sick.

Please vote for more golden years for yourself, children and grandchildren.

Anonymous said...

I always wondered and we should ask ourselves why or how come health care costs can inflate so much.

Breakdown health care costs into doctors, nurses, toilets cleaners and water/electricity, maybe still got some others.

We will examine totally where the high costs come from.

Take note that relative to some other countries, our public hospitals does not fare well in terms of nurse to patients ratio. That means one nurse is attending to more patients. I read this somewhere from online citizens, need to verify.

This is like the town councils and service and converancy charges. We don't have minimum wages and we hire bangala workers to do those clearing the rubbish and cleaning work and their wages remain the same as 10 years ago. Where is there a need to hike fees?

Anonymous said...

In America, better not get sick.

In 1990, while on a working trip to US, I got a fever and cold.

The consultation fees alone is US$100+. And the place is only a surburb of a big city.

I got a prescription and had to go find a pharmacy to buy and pay separately for the medicine which is about US$20+.

Luckily I recovered in 2 days.

Anonymous said...

One of the reasons for increase in medical fees is that there's a guaranteed source of payment for the prices that hospitals set. This applies to both medical insurance and government medical subsidies.

This allows hospitals, pharmaceutial companies, medical equipment companies to set their prices high since there's a willing and guaranteed payer for these services.

Anonymous said...

Not sure if anyone here is aware...half the costs of developing a drug goes into high class seminars and hotel stays for the senior hospital doctors & directors invited to sit in!

Anonymous said...

Which part of 'You die your business', do you not understand?

Anonymous said...

I tot u dun believe in Michael Moore?

Anyway, the pitfalls is common knowledge.
Best insurance is a rich son-in-law.
Next best is employment with a MNC that provides decent medical benefits.

Or be on the pension scheme like .. say the ministars.

Otherwise u die ur business.

Anonymous said...

Dear Lucky

Just a suggestion. Hope you can schedule your articles such that the time gap between them is not too close. You are such a prolific writer and your last 5 or 6 articles were posted within a period of 5 days.

Some readers would like to post their responses in the previous articles but given that people tend to treat the latest article as more current (somewhat like news), they might give it a pass but may even forgo reading your previous articles.

Thank you!

Anonymous said...

I agree with Anon 21.31

More than what he mentioned, there is also the pay-off to silence the insiders who know about the negative and side effects of the drugs.

Have you ever wonder why is it that the side effects of some drugs are only made known, after complaints from users, when they were supposed to have been tested on animals and then people for many years?

Money can do wonders.

Anonymous said...

Should PAP ever gets voted out people will find there is big hole inside - countless $billions lost by Temasek and GIC through stupidity, deliberate choice or otherwise (what is that, think how money can be creatively manipulated, creative accounting they call it).

Some people think it is not possible for people to throw out PAP. They say where's the credible opposition with enough organisation?

Ahhhh, isn't this is what PAP seems to believe, which is:

:: Let us deprive the people of credible would-be opposition people through harsh treatment, by sueing prominent challengers to bankruptcy and jailing them, and making life difficult for opposition in general.

:: Let us incorporate any prominent people like successful businessmen, industry and community leaders into PAP circles via awards, study committees, informal consultant groups, what-have-you if not as MPs, Ministers.

:: Let us spread PAP presence so far and wide in the spheres of community (PA,CC,RC,Kindergarten), commerce (GLCs like those of Temasek companies, NTUC, "privatised" hospitals ...). Then employees of these companies will feel an obligation to be loyal to PAP.

Clever.

But does PAP seriously think people cast their votes based on pure logic or rational calculation alone.

In 1987 GE the support for PAP fell very drastically despite the fact that the opposition was "in shambles" in the words of veteran opposition candidate Lee Siew Chow (former Barisan Socialis' chief).

People especially businessmen were angry with PAP for not doing enough during the 1987 recession.

So they just spoke through their votes. Some opposition candidates the "Ah Peks" and "Ah Sohs" did not so much as show their faces despite being completely new to voters but merely put up their posters with their portraits around the wards and they managed to garner more than 40% of the votes.

So the point is this: When people are unhappy with the government, their action would be instinctively defensive of their own interests. Rational consideration is not always a choice under the circumstances.

PAP needs not fall but it has to seriously revamp itself. There is too much status quo, too much yesmanship even when things are falling apart. Think of the tens of $billions thrown and lost into Western banks which some say is really a gift to them and why? Because the timid anglophlie and bananaman (i.e. "yellow outside but really white inside" according former Chinese Premier Zhou Enlai) LKY said so out of fear that the West would desert him in some way?

Small country but run this way. Things will come to head at this rate. So better for PAP to go in my opinion. I am not worried there won't be good people to take over.

Just don't look too shortsightedly about political talents. There are lots polilitcal talents around, according to LKY himself at one time but later he changed his tune when he wanted to justify $millions salaries for themselves.

Anonymous said...

Anon 15.52

You must understand that the opposition strength and numbers needs lots of time and to be gradually built.

For instance the DPJ of Japan started as a breakaway of LDP as early as 1992 before they won the recent elections.

With the state of the opposition now and their "growth" over the past years, you think it can be like the DPJ of Japan anytime soon?

Or do you even think a breakaway faction can happen to the PAP with the fat pay and perks of MPs and ministers?

That's why LKY is so confident for at least 2 more elections for PAP.

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http://www.ted.com/talks/lang/eng/dan_pink_on_motivation.html

Anonymous said...

One may get more sick from buying insurance to cover expenditures of illnesses.

All those small prints and technical/legal jargons in the contracts are beyond the understandings and interpretations of most layman.

patriot

CT Ong said...

in general, insurance company will try to reduce the claim amount. the customers need to be firm, fight back with facts and not shut up and sit down and take the c**p that is dished out.
Recently i accidentally injured myself during exercise and went for physio treatment. Exercise injury is covered under my PA plan but my claim was rejected. The insurance co in its letter said an accident is an involuntary and unforseen circumstance which lead to injury. under this definition, what happen to me doesnt constitute an accident. I refused the explanation, stood my ground and appealed my claim, backing up with facts to show its an accident (common, why would i injure myself voluntarily??). Two months later, the co relented and paid my claim in full.

Anonymous said...

oh oh, time for the pap to set up some tripartite case-like association to look into insurance disputes and judge in favour of the companies...

man against the tank said...

Besides Sicko:
http://www.harpercollins.com/books/9780060875671/MoneyDriven_Medicine/index.aspx

http://newsreel.org/nav/title.asp?tc=CN0225

read the book ,watch the movie...it is closer to us on this island than you think.

Anonymous said...

Breakdown health care costs into doctors, nurses, toilets cleaners and water/electricity, maybe still got some others.

Discovering and pinpointing exact causation of high health care costs, and coming up with solutions is what being paid the highest polotician,

Not cannot do anything about medical inflation and suggests go to Johor for cheaper heath care.

Like that no need to be paid millions.

Anonymous said...

Anon 19:35,

What you said is true but it does sounds funny.

Imagine if we can say this to PAP politicians:

Like that no need to be paid millions LOL!

This joke is priceless. Nxt time they come up with another stupid mistakes and excuses, I must remember to say:

Like that no need to be paid millions! haha

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Anonymous said...

interesting->
http://www.businessinsider.com/group-of-nuns-attacks-goldman-over-large-bonuses-2009-10

Anonymous said...

Anon of 10/10/09 19:25,
When you say: "In America, better not get sick.", please remember that you are not an American citizen!

American citizens can get sick very happily, compared to Singaporeans. The bulk of them have their insurance paid by their employer, while those below the poverty line have their insurance paid by the government.
(Those who are above poverty line but has no employer-paid insurance are in the minority, even though they are in the millions, because usa has a large population and millions is still a small percentage)

These insurance are the bao kao liao type, that cannot be found in Singapore! Meaning: Except for some not-so-good insurance that are in the minority, the majority pays for all outpatient and inpatient treatment with no co-payment required, and it covers congenital conditions and pre-existing conditions too!

And no, it does not mean high-tax, because the insurance premium is paid by employers (for those working) and by a govt that allocates 16% to healthcare instead of Sg's 4% (for those below poverty line). So it's not about tax collection, but how tax is allocated.

I know, because I am now working in USA, as can be seen from the time of this comment :)

Anonymous said...

Not all employed enjoy insurance coverage by employers in America. Many medium or small companies don't provide insurance coverage; and, some companies make the employees pay certain percentage. Minimum monthly sum for a family of four (2 adults and 2 children) is about USD400-500.

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Anonymous said...

There has been a great number of articles in the foreign media recently painting the Singapore health system as some kind of paragon. It's good but as pointed out above, there are big flaws. And the biggest is that the system is adversarial and pits insured and insurers in a zero sum game where both are encouraged to be less than truthful.

My personal experience is that agents selling health insurance policies will encourage customers to omit relevant medical history items that the application form specifically asks for as they know that the underwriters will use this as grounds to refuse the application. The refusals can be for quite trivial pre-existing conditions, and can cite reasons which are basically science fiction.

And a doctor has personally told me that there recently was an insurance company ringing around all the clinics in his local area, trolling for info on a seriously ill customer of theirs who they suspected had not declared a pre-existing on their application.

So here's how it 'works':
*Applicants omit pre-existings on their applications because otherwise it'll be refused (even for the most trivial pre-existings)
*Insurance companies know that a large proportion of policies were issued with missing pre-existing declarations and wait for the patients to get sick
*Then the insurance companies go looking for evidence of the omissions.

Great system? Think again!