Recourse for Patients Provided with Outdated Information on Eligibility for On-panel Benefits for Hospitalisation Expense Claims under Integrated Shield Plan

6 Dr Tan Wu Meng asked the Minister for Health (a) whether data is available since 2021 on how many cases have been raised to the authorities involving disputes on whether a hospital has provided inaccurate or outdated information at the material time on whether a patient qualifies for on-panel benefits when claiming for hospitalisation expenses under an Integrated Shield Plan; and (b) what avenues for redress and dispute resolution are available to affected individuals.

The Senior Parliamentary Secretary to the Minister for Health (Ms Rahayu Mahzam) (for the Minister for Health): Mr Speaker, the Ministry of Health (MOH) does not track such data. However, we are aware of a few cases where medical providers have conveyed information that may have led patients into thinking that their medical bill would qualify for panel benefits or be fully covered by insurance.

Affected patients are encouraged to resolve their concerns directly with the medical provider first. Failing which, they may consider filing their dispute with the Clinical Claims Resolution Process (CCRP), which helps to resolve clinical matters pertaining to Integrated Shield Plan (IP) claims or seek mediation with the healthcare institutions facilitated by MOH Holdings' Healthcare Mediation Unit.

Mr Speaker: Dr Tan Wu Meng.

Dr Tan Wu Meng (Jurong): I thank MOH for the answer. I have got two supplementary questions. As illustration, I have a Clementi resident who sought treatment at a private hospital. The hospital website said at the material time that the doctor and the doctor's clinic were covered on their insurance company's panel. The doctor affirmed that it would be covered on the insurance company's panel.

After the treatment, the insurance company said it was not covered and it was not on the panel. Yet, six months later, my resident showed me, on my resident's handphone, that the private hospital still reflected that doctor and that clinic as being on the panel. When my resident appealed to the Monetary Authority of Singapore (MAS), they recommended that he contact the insurance company. When my resident appealed to MOH, he was referred back to the doctor and the insurance firm. In the meantime, the private hospital sent debt collectors after my resident.

Can I ask the Ministry who can consumers best seek help from in these situations? Is there a "no wrong door" policy to guide consumers, because consumers sometimes worry whether every door seems the wrong one in such situations?

Secondly, can I also ask what recourse is there if the hospital provided outdated information, the consumer acted on the outdated information and thereby suffered financial disadvantage? Are there lessons which can be learnt from the Consumer Protection (Fair Trading) Act 2003 regime, the Competition and Consumer Commission of Singapore (CCCS) and the Ministry of Trade and Industry (MTI) that could be applied to this as well?

Ms Rahayu Mahzam: I thank Dr Tan for sharing his resident's situation and for raising the supplementary questions. I can appreciate his concern in this case.

The Member had asked about the agency to refer to and the recourse available to the consumers. For disputes involving miscommunication between the patients and medical providers, the patients may consider writing in to MOH Holdings Healthcare Mediation Unit for mediation services, if they are not able to resolve the matter with the provider.

And if they are then still not able to resolve that through mediation, the other possible avenues include recourse through the Consumers Association of Singapore as well as the Small Claims Tribunals.

The case that Dr Tan has surfaced is, indeed, an unfortunate one. It is a situation where there was a misunderstanding on the doctor's part and also a miscommunication on the hospital's part. This is a good opportunity to remind all stakeholders to play their part in helping patients make informed decisions about their panel benefits.

The hospitals that wish to inform patients of the doctor's panel status should ensure that information that they have provided is updated and the doctors should also inform patients of any changes in their panel status as soon as possible. The insurance company and their agents should also remind policyholders to first check the panel status of the doctor before going for the treatment and explain the implications of the insurance coverage.

When everyone plays their part, situations like this could be avoided. So, I appreciate the Member's concerns. But in this case, it was really one of those few cases that we have seen where there was a misunderstanding and miscommunication. If everybody had followed according to what they were supposed to have done, this situation could, indeed, have been prevented.