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IP insurers to have more specialist doctors on panels

IP insurers to have more specialist doctors on panels

Source: Straits Times
Article Date: 10 Nov 2021
Author: Salma Khalik & Linette Lai

Policyholders and doctors alike have often complained about the small number of private specialists on the panels of some insurers.

The 2.85 million people here with Integrated Shield Plans (IPs) will have a wider choice of specialist doctors on the panels of the seven insurers that offer such plans.

Patients, insurers, doctors and medical institutes with grievances can also turn to a new resolution platform set up yesterday.

The Ministry of Health (MOH) announced these changes as part of its move to address issues related to MediShield Life-linked private health insurance.

Policyholders and doctors alike have complained about the small number of specialists on the insurers' panels. At the start of this year, the panels of the seven insurers had between 190 and 409 private sector doctors on them.

Now, four of them - AIA, Aviva, AXA and Great Eastern Life - have committed to having at least 500 specialists on their panels by the end of this year; NTUC Income and Prudential will have at least 450; and Raffles Health Insurance will have 250. Some have already reached their targets.

As at end-August, 79 per cent of the 1,235 eligible private sector specialists were on at least one insurance panel, up from 70 per cent at the start of the year.

Insurance panels are important as the 1.71 million policyholders who have riders to cover part of their portion of the bill have certain perks, such as paying no more than $3,000 a year of their bills, if they use doctors on the insurer's panel. The cap may not apply if they use non-panel doctors.

But there have been complaints that a small panel gives patients limited choice. Some doctors have also complained about being rejected by insurers. Most insurers say they want doctors with at least five years' experience on their panels.

MOH set up a Multilateral Healthcare Insurance Committee in April to look at how to better address disputes, and expand the size of IP insurer panels. The ministry has accepted the committee's recommendations.

IPs, which are integrated with the basic MediShield Life, cover patients for private medical treatments, so they need to pay only the annual deductible - which ranges from $1,500 to $5,250 depending on the class of care and age of the patient - and 10 per cent of the rest of the bills.

To slow down runaway healthcare costs, MOH imposed a minimum co-payment of 5 per cent of the bill, subject to a minimum cap of $3,000 a year for patients with riders bought after March 8, 2018.

Also announced is a new resolution platform that insurers, doctors, healthcare institutions and policyholders can turn to for help in case of clinical-related disputes. Called the Clinical Claims Resolution Process, it is voluntary, so all parties must agree to participate.

Should a doctor be found to have overcharged or over-serviced, the Academy of Medicine will provide guidance, with a senior practitioner in the same field providing counselling to help the doctor, said Professor Teo Eng Kiong, master of the academy. The doctor must agree to participate but his refusal may be documented and taken into account by the profession's watchdog, should he be recalcitrant.

Senior Minister of State for Health Koh Poh Koon said this resolution process "closes a gap" for resolving disputes.

Only the party complaining needs to pay a fee - $50 for the patient, $200 for the doctor and $500 for the insurer or medical institution - with the bulk of the cost borne by the ministry. It expects about 50 to 60 such cases a year, with costs to be between $200,000 and $400,000 a year.

To prevent frivolous claims, disputes raised by insurers, medical institutions and doctors require at least two prior related disputes with the other party within the past five years. There is no such requirement if a patient raises a dispute.

The disputing parties as well as the five members of the adjudicating panel will be anonymised, to prevent any possible conflict of interest, such as panel members helping out a colleague.

What do bigger medical panels mean for patients?

Two fixes have been introduced to tackle common issues raised over Integrated Shield Plans (IPs) - the private top-up to basic public health insurance here.

First, a new process has been set up to resolve insurance claim disputes. IP insurers will also bump up the number of doctors on their medical panels, giving policyholders more choice.

These changes were recommended by the Multilateral Healthcare Insurance Committee, set up to study issues such as the accessibility of IP doctor panels and the overarching problem of rising healthcare costs.

Q: What do these changes mean for patients who have medically related claim disputes?

A: If they cannot settle the issue with their insurer, they will be able to bring a complaint under the new resolution process.

Disputes can be filed online and a five-member panel will be convened to look into the issue. This will consist of three doctors of the relevant speciality and two medical directors from other IP insurers. The Consumers Association of Singapore will also support the panel as a consumer advocate.

Each individual - including the complainant and panellists - will not know the identity of any other person involved. This means panellists will also not know who else is on the panel.

The aim is for a decision on each case to be made within 12 weeks.

Q: What kinds of disputes are covered and how much will it cost to file a complaint?

A: All disputes must be medically related and both parties must voluntarily enter into the dispute-resolution process.

Doctors and insurers will have to show proof of at least two related disputes within the past five years, to show a pattern of such issues.

If you are a policyholder, you will have to pay $50 to file a complaint. But if a doctor raises a complaint, he will have to pay $200 and an IP insurer or other corporate entity will have to pay $500.

Q: Why are IP insurers increasing the number of doctors on their medical panels?

A: All IP insurers have their own panel of preferred doctors that policyholders are encouraged to choose from. But both patients and private specialists have complained of the small number of doctors on such panels.

In March, a group of specialists expressed this unhappiness with IP providers in a position statement by the Singapore Medical Association. They also took issue with how panel doctors are typically paid at the lower end of fee benchmarks.

They gave examples of how patients had reluctantly switched doctors after being given a major diagnosis, as they were worried about racking up high out-of-pocket fees. Many insurers place a cap on the amount that patients have to co-pay, but only if the doctors the patients choose are on their panels.

But the Life Insurance Association responded that if insurers "recklessly increase" the size of panels, premiums will rise significantly. As medical panels were initially mooted as a cost-control measure, adding even more doctors would erode this impact and result in insurers looking for other ways to compensate.

Since the start of this year, the healthcare insurance committee has worked to raise the number of private specialists on each IP insurer's panel by 7 per cent to 63 per cent. Six of the seven insurers have also pledged to have around 500 private specialists on their panels by the end of this year. The make-up of these specialists will depend on insurers' client base.

Source: Straits Times © Singapore Press Holdings Ltd. Permission required for reproduction.


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