All integrated shield plan (IP) insurers will provide coverage for diagnostic endoscopy - a common procedure that allows doctors to look inside a patient's body and detect diseases - when it is medically necessary, the Life Insurance Association, Singapore (LIA) clarified in a statement yesterday.
This means that one insurer, which disallowed such claims recently, will no longer be doing so.
The statement comes after the Singapore Medical Association (SMA) said in an Aug 29 letter in The Straits Times Forum section that some insurers - without naming any - are no longer allowing claims for diagnostic endoscopies, even when they are medically required.
It prompted an outcry among specialists.
LIA said that "among the seven IP insurers, only one insurer previously had stricter claim rules in relation to gastrointestinal endoscopy, consistent with their policy terms and conditions".
The insurer has "since aligned its practices with prevailing industry norms and policyholders can be assured that their medically necessary diagnostic endoscopies will be covered by all IP insurers", it added.
This insurer is Aviva.
When contacted, its spokesman said that since March this year, the firm had started to take "a stricter stance in claims assessment towards a small number of claims for standalone endoscopies that were not associated with in-patient treatment or hospitalisation".
He said this is in line with its policy terms.
"We reviewed this practice in August and subsequently decided to approve claims for endoscopies because they are day surgeries, even if they do not lead to in-patient treatment or hospitalisation," he added.
"We had already started approving new claims for standalone endoscopies in August, and will be initiating revised claim settlements for such endoscopy claims that were previously rejected."
Doctors ST spoke to said some affected patients have had to pay out of their own pocket and some had said no to the procedure, though this may cause a delay in diagnosis and worsen the patients' condition.
Dr Ng Chee Kwan, the SMA's first vice-president, said that until early this year, all insurers would cover the costs of diagnostic endoscopies for their clients with IPs, as part of their coverage for all day surgery and hospital admissions.
He said the procedure is the only reliable way of detecting some of the more common cancers here, such as colorectal cancer, gastric cancer and nasopharyngeal cancer.
The president of the Society of Colorectal Surgeons (Singapore), Dr Ng Chee Yung, said he noticed from the start of the year that "some insurers started to either categorically stop coverage or started a process of their own vetting - through pre-authorisation - that would question the specialist's indication for the procedure and ultimately deny the coverage in many instances".
The cost of diagnostic endoscopy varies - there are different types, and it may range from below $500 to $3,000 and above.
Dr Tan Wu Meng, chairman of the Government Parliamentary Committee for Health, highlighted SMA's ST Forum letter in Parliament earlier this week, saying that when an insurance firm moves the goalposts for an IP plan, it is not so easy for a patient to switch providers as his existing health conditions become pre-existing conditions under the new policy.
Gastrointestinal endoscopies are among the most common procedures seen in IP claims.
Responding to media queries yesterday, the Ministry of Health said that in recent years, "insurers have introduced claim management policies to promote appropriate utilisation of medical care as part of their efforts to keep healthcare costs affordable and sustainable".
"We encourage insurers and clinicians to work together closely to develop and review these policies, to ensure that these encourage appropriate medical diagnosis and care, and are beneficial for policyholders."
