Integrated shield plans are insurance policies that cover expenses incurred when patients are hospitalised. They are an essential component of the healthcare system in Singapore.

Insurance companies that provide shield plans have recently further tightened their review processes for claims and implemented changes to limit their costs.

In the past, insurers covered the cost of diagnostic endoscopies, in line with their coverage of all surgical procedures that require hospitalisation.

However, some insurers are no longer allowing claims for diagnostic endoscopies, even when they are medically necessary.

There are now numerous instances where insurers have not approved the coverage or rejected claims for diagnostic endoscopy, on the basis that the doctors have not tried to treat their patients with medication before recommending the endoscopy or that the insurance policy does not cover diagnostic procedures.

This disrupts a crucial part of doctors' assessment. For example, a doctor who is concerned that a patient may be suffering from a serious condition such as a peptic ulcer or bowel cancer may recommend that the patient go for diagnostic endoscopy so that the doctor is able to recommend the appropriate treatment after that.

Insurers disallowing claims for diagnostic endoscopies may lead to patients choosing not to go for them, which may lead to a delay in diagnosis and worsening of their condition.

Insurers are interfering with patient management if they suggest that doctors try to treat patients with medication first; taking medication may suppress symptoms without treating the underlying condition.

Insurers that argue that their policies do not cover diagnostic procedures are setting a dangerous precedent, as one day they may decide to withhold coverage for other medically necessary surgical procedures which are performed for diagnostic purposes, such as biopsies.

We hope patients will critically assess their shield plans to ensure that these provide the necessary coverage for their healthcare needs.

We also urge the Ministry of Health (MOH) and the Monetary Authority of Singapore (MAS) to look into this matter.

Patients use their Medisave to pay part of their shield plan premiums, so oversight from

MOH and MAS is necessary to ensure that shield plans provide adequate coverage.

Ng Chee Kwan (Dr)

1st Vice-President

Singapore Medical Association

This letter is written with the support of the Gastroenterological Society of Singapore and the Society of Colorectal Surgeons (Singapore).