How to choose an Integrated Shield Plan insurer

The administration of Integrated Shield Plans (IPs) has been in the news recently following a spat between the medical fraternity and life insurers.

On Wednesday (April 14), the Ministry of Health (MOH) announced the appointment of a 12-member committee comprising representatives of both groups as well as Singapore’s consumer watchdog to “collaboratively address” issues related to health insurance here.

Currently, there are seven IP providers in Singapore offering comprehensive health insurance for hospitalisation in private hospitals.

Details of their products vary widely and in choosing the best one to suit their circumstances, members of the public should not just compare their prices.

Why is this so?

Well, you only know how good an umbrella is when it is raining heavily. Similarly, you would only know how good your insurance policy is when you fall ill.

As a private specialist, I encounter patients with IPs every day. Many discovered their IP policies were inadequate or non-comprehensive only when they were sick, which is too late.

To help members of the public choose a good IP policy, I have listed a series of factors to consider.

1. How does your IP provider manage pre-existing illnesses?

You must declare all pre-existing or past illnesses to your insurer when purchasing an IP policy.

Some chronic illnesses such as hepatitis B may linger on to cause complications in future and may be excluded from certain IPs.

But many illnesses, such as acute appendicitis, occur once and have no long term sequelae, that is, conditions arising from that previous condition.

They should not become an exclusion in your IP contract.

Yet, I have seen IP providers excluding the whole hepatobiliary pancreatic tract in hepatitis B carriers.

I have also seen patients with piles have their whole gastrointestinal tract excluded from their insurance coverage.

These exclusions are not exactly fair, as hepatitis B does not harm the gallbladder, biliary tree, or the pancreas. And piles would not affect the rest of the digestive tract.

Do talk to your doctors before accepting any exclusion criteria in your application.

2. How long does it take to get approval for pre-authorisation?

Several IP providers require pre-authorisation to be given by them before a surgery is done.

This is good as once approved, patients can have peace of mind to undergo their surgeries without worrying if their claims will be approved later on.

But different IP providers take different periods of time to give the approval.

One particular IP provider would approve (or reject) pre-authorisation within three days, sometimes even within an hour.

But there are also other IP providers which would take a week or more for approval.

This affects how the medical team would arrange the surgery and admission. For the fast approver, I can list their endoscopies three days after the initial consultation.

But for the slow approvers, I often list their procedures 10 days later.

Ask your IP providers their median (range of) time for pre-authorisation approval.

3. How long does the IP provider take to pay claims to patients and doctors?

When a pre-authorisation is approved, a letter of guarantee (LOG) is issued by the IP provider to the hospital. A LOG is a promise that payment will be paid by the IP providers.

But different IP providers take different periods of time to pay the hospitals. While most IP providers settle their bill within 60 days, some would drag on for more than six months.

If an IP provider has a bad reputation in paying the bills promptly, some doctors may be unwilling to accept patients from that IP provider.

4. How reasonable are the IP providers in assessing claims?

A pre-approval does not necessarily mean that all the items in the discharge bill will be completely reimbursed by the IP provider.

Certain medications, investigations and referrals to other specialists may be queried or rejected. The patient may be asked to foot the cost of these items.

Recently one IP provider declined to reimburse digestive endoscopies to its clients, even when most of such scopes are recommended by doctors and covered by other IP providers.

That IP provider made a U-turn after doctors raised concerns.

5. Size of their panel specialists

Over the years, many IP providers have introduced “panel specialists”. Clients are encouraged to consult specialists on their panels to enjoy certain financial and logistical advantages.

But some IP providers have insufficient specialists on their panel, which means that their clients are forced to consult non-panel specialists.

I just had a patient with an acute stroke in a private hospital. I needed a neurologist urgently. But there was only one neurologist there.

Luckily, he was available and came to the patient’s rescue urgently.

You must choose an IP provider with enough specialists in all specialties, at all private hospitals.

6. Depth of the panel

Numbers do not tell the whole story.

There are many subspecialties within each specialty. One typical example is orthopaedics. Very few orthopedic surgeons are expert in all the joints. There are subspecialties in spine, shoulders, elbows, hips, knees, ankle and feet.

Some panels may not contain an adequate number of subspecialists.

You may not want an ankle surgeon to perform a complex knee replacement.

Choose an IP provider with a substantial depth of subspecialists.

7. Disincentive for consulting non-panel doctors

Different IP providers implement different levels of disincentives when their clients choose to consult non-panel doctors.

This could include higher co-payments or a shorter period of post-discharge coverage.

Do read the fine print to see the penalty or disincentive when you choose to see a non-panel specialist.

8. How well does the IP provider pay their doctors?

To attract senior and experienced specialists to join their panels, IP providers must pay their doctors reasonably.

Some panel specialists may decline to operate on complex and high-risk cases if the fees are too low.

Choose a reasonable payer.

9. Duration of post-discharge outpatient cover

Most IP providers would continue to reimburse outpatient care after discharge from hospitalisation.

But the duration of cover differs widely, ranging from three months to 13 months.

For complex diseases such as inflammatory bowel disease or gastroesophageal reflux disease, long-term follow up is important, as most of these conditions would not be resolved within three months of the time of diagnosis.

Do compare the duration of post discharge coverage.

To conclude, each of the seven IP providers has its own strengths and weaknesses.

Members of the public should do their due diligence in researching all factors I have listed when they decide to purchase or continue with any IP policy.

ABOUT THE AUTHOR:

Dr Desmond Wai is a gastroenterologist and hepatologist in private practice.