An elderly Singaporean who expected that MediShield Life would cover 90 per cent of his post-subsidy bill for a cataract was left shocked when the national health insurance scheme only paid out $4.50 of the $4477 cash bill.
82-year-old Mr Seow Ban Yam underwent a cataract operation on both eyes at the Singapore National Eye Centre and received a bill that came to over $12,000. After government subsidies, Mr Seow needed to pay $4477.
Mr Seow paid $3000 of the remainder from his Medisave account. The elderly Singaporean thought that MediShield Life would cover the lion’s share – specifically, 90 per cent – of the remaining $1477. He was in for a rude shock when MediShield Life only paid out less than a measly $5.
MediShield Life explained that it imposes a $2,800 cap on the procedure Mr Seow underwent. This does not explain why the Singapore National Eye Centre charged Mr Seow $4,477 post-Government subsidy.
This means that the maximum reimbursable amount for such a procedure each year is $2800 + plus actual ward fees of $205. This amounts to $3,005.
Of this $3,005, $3000 has to be taken from the patient’s own CPF funds. This leaves only $5 that is claimable by insurance. Thus, MediShield Life paid 90 per cent of that $5 – amounting to $4.50.
Mr Seow lamented that having a lower cap on the cost of procedures defeats the purpose of MediShield Life to help meet heavy medical bills that Singaporeans face.
The Ministry of Health (MOH), however, indicated that Mr Seow’s situation is due to the healthcare institution he visited.
Noting that the bills for more than 9 in 10 subsidised patients undergoing the same procedure as Mr Seow are within MediShield Life claim limits, MOH said: “As the national referral and tertiary eye centre, SNEC’s cost and fee structures are higher than those at other public healthcare institutions.”
MOH promised to review claim limits and premiums in two years, by the end of 2020, to take into account “actual claims experience and healthcare cost inflation”.
Several Singaporeans sympathised with the elderly Singaporean’s plight. . Award-winning cartoonist Sonny Liew is among those who were left confused as to how the authorities came up with the cap on the procedure:
https://www.facebook.com/sonny.liew/posts/10156778420896181