More flexibility needed over electronic filing of medical claims

In senior health correspondent Salma Khalik's report, the Singapore Medical Council "acknowledged that there is no prohibition against hospitalising a patient for what is normally a day surgery", even as it warned doctors not to do so if it was unnecessary (Doctors warned against overcharging, overtreating; March 20).

I believe there are occasions when patients are hospitalised for day surgery because that is the only way the doctor can submit an insurance claim on behalf of the patient, due to the Ministry of Health's (MOH) mandate for electronic filing of claims.

MOH imposed electronic filing to facilitate efficiency in processing paper work, including for Medisave reimbursements, and insurance claims.

Most specialist clinics run a tight ship to keep costs manageable. But, the digital push to boost efficiency has added to their cost as they need to hire additional staff to do electronic filing.

Patients who opt for day surgery are unable to claim their insurance cover if a specialist clinic does not have staff to do electronic filing.

The only option is to be hospitalised since all hospitals, public and private, are set up to comply with the MOH mandate of electronic filing.

I have personally had my claim turned down by my insurer because I opted for a day surgery procedure in a specialist clinic without electronic filing.

In my attempt to save the insurer from paying a higher claim, I ended up being denied my claim by the insurer.

Our bureaucrats must pay attention to details when implementing government policies.

The insurers must realise that refusing to accept non-electronic filing is not saving them from bigger claims. But, again, what can they do if MOH says all claims must be electronically filed?

Let me give you a frightening scenario.

Suppose I have to seek medical help overseas while travelling, and the hospital or clinic in that country has no facility to file my claim electronically to my insurer.

Would my insurer deny me my claim in this situation?

Would Medisave refuse to reimburse my insurer because my claim did not comply with MOH's mandatory electronic-filing protocol?

Thomas Lee Hock Seng (Dr)

A version of this article appeared in the print edition of The Straits Times on March 22, 2018, with the headline 'More flexibility needed over electronic filing of medical claims'. Print Edition | Subscribe