Computing a claim on a hospital bill

Hi Mr Tan,

What is the deductible under a medical insurance plan? Why are there so many items deducted from my hospital bill? The amount that I can claim is only a part of the full bill?

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REPLY:

The amount that can be claimed may (depending on your insurance plan), be subject to the following limits:

* limit based on the specific item, such as surgery fees or each day of stay in hospital

* deductible, i.e. the first part of the bill that is paid by you (before you can claim on the difference)

* co-insurance, i.e. the portion of the bill (in excess of the deductible) that you have to bear.

Most Shield plans have a deductible (the amount depends on the class of ward) and a co-insurance of 10% or 15%. These requirements are required by the Ministry of Health and is intended to require the consumer to share in part of the bill (so that they can play a part to minimise the hospital bill).

This is how a hospital bill is calculated, to arrive at the claimable amount.

1. First, the individual items are scrutinised to remove any excess over the specific limit (e.g. for surgery or hospital services) or items that are not covered
2. Next, the deductible is taken away
3. Finally, the co-insurance is taken away from the rest of the bill

Here is an example:

Hospital bill: $6,500
Non claimable items: $500
Deductible: $1,000
Co-insurance: 10%
Claimable amount (before co-insurance) = $6,500 - $500 - $1,000 = $5,000
Claimable amount (after co-insurance) = $5,000 less 10% = $4,500

Many consumers find it the calculation to be too complicated. I agree with this view. It will be better for the claim to be simplified.