Hospitalisation Claims: What You Need To Know and How To Do It

This was originally posted on Planner Bee.

Hospitalisation can be a stressful and overwhelming experience, both physically and financially. Fortunately, insurance can help ease the financial burden of medical bills.

However, navigating the claims process can be confusing and complicated, especially if it’s your first time doing so. In this article, we will address some common questions related to hospitalisation claims in Singapore.

First, we need to highlight that there are different types of hospitalisation insurance in Singapore. They are:

• MediShield Life
• Integrated Shield Plans (IP)
• Group Hospitalisation and Surgical Insurance
• International Health Insurance

As reported in Straits Times on 21 April 2022, around 70% of Singaporeans and permanent residents, which translates to about 2.9 million people, have opted for Integrated Shield Plans (IP) to provide coverage for private medical care. We will touch on the claim process using Integrated Shield Plans (IP) here. Some of the details shared in the claim process may apply to the other types of hospitalisation plans.

Common Types of Hospitalisation Claims

Inpatient

This includes charges incurred for the daily room & board, medical-related services, intensive care unit (ICU) and surgical benefits.

Day Surgery

It will include charges incurred for the day surgery procedure and other medical-related services.

Pre-Hospitalisation

It will include charges such as consultations, diagnostic procedures and laboratory examinations prior to the admission of the same medical condition.

Post-Hospitalisation

It will include charges such as follow-up consultation and treatment incurred after you are discharged as an inpatient. This must result directly from the same medical condition that led to the inpatient treatment, and also be recommended by the attending doctor who treated you.

Major Outpatient Treatments

This includes the costs required for the treatments as an outpatient. Examples are kidney dialysis and cancer drug treatment & cancer drug services.

Apart from the above common types of hospitalisation claims, some benefits in IP will only come into effect after the waiting period, which will vary depending on the insurance company and benefit type.

Read more: Why You Seriously Need To Consider Private Medical Insurance

Typical Claim Process

• Pre-authorisation approval of the claim by the insurance company is required if you are seeking medical attention in a private hospital. You are advised to choose the specialist from the insurance company’s panel list of specialists. This will help you to enjoy higher benefits in the event of a claim.
• On the day of your admission, you will be asked to complete the Medisave Authorisation Form unless this was done during the financial counselling process. A Letter of Guarantee can be electronically raised by the Hospital Admission Staff and this will help to waive the deposit.
• On the day you’re getting discharged, you may be asked to settle the full payment of the hospitalisation As IP is designed to be a reimbursement plan, you should be aware that this could happen at the point of your hospital discharge so it’s good to be prepared. Please remember to get a copy of the inpatient discharge summary report and other medical reports/lab test results.
• Within a few days to a week, the hospital should e-file the hospitalisation bill to the insurance company for the claim assessment. Once the insurance company receives the e-filing, they will start their internal claim process,which includes liaising with the CPF Board to assess MediShield Life’s share of the claim.
• Once the claim assessment is completed by the insurance company, they will transfer the claim payout to the hospital. Upon receiving the claim payout from the insurance company, the hospital will do a final billing process and a Final Tax Invoice will be sent to you. If there is any amount that was initially paid by you and you should be reimbursed for it, the hospital will arrange to have that amount refunded back to you.
• For any pre-hospitalisation and post-hospitalisation treatments bills, you will need to submit them to the insurance company yourself or through your trusted financial consultant. As for the duration which you can claim your follow-up treatments for, please refer to your IP product information, as it varies across different insurance companies.

Read more: I Already Have Hospitalisation Insurance. Why Do I Need a Critical Illness Plan As Well?

Making a hospitalisation claim can seem daunting at first, but with the right information and preparation, it can actually turn out to be a straightforward process.

It’s important to understand your insurance coverage, keep track of your medical records, and follow the hospital’s admission and discharge procedures. By submitting your claim promptly and following up with your insurance provider, you can ensure a smooth claims process and receive the financial assistance you need to cover your medical expenses.

Read more: Singapore’s Integrated Shield Plans to Stop Paying for Entire Hospital Bills