Over the past year, several reports and official statements in Singapore have highlighted consumer concerns over insurance disputes, claim denials and the gap between policy wording and consumer expectations.
In healthcare, this gap can become especially troubling when patients discover, only at the point of crisis, that timely treatment, safer options or real-life complications do not fit the narrow definitions set out in their policies.
As a practising obstetrician, I have seen examples of this mismatch in maternity care.
A woman with severe bleeding after childbirth may sometimes be saved by a special surgical stitch that controls the bleeding while preserving the womb. This can avoid a hysterectomy and preserve her ability to have children in future. However, if an insurance policy recognises only removal of the womb, successful womb-saving treatment may end up counting against the patient.
A similar issue arises with pre-eclampsia, a potentially life-threatening pregnancy complication. Although considered by many as “high blood pressure” in pregnancy, it can worsen quickly and unexpectedly and may lead to seizures, stroke, organ failure, stillbirth or death if treatment is delayed.
Doctors act promptly to protect mother and baby once the diagnosis is clear. In real life, we do not wait around for the condition to become even more dangerous in order to tick off more boxes on an insurance checklist. However, if a successful claim depends on older definitions or repeated test results taken hours apart, it raises the troubling question of whether timely treatment is being penalised.
Even maternity insurance can fail in unexpected ways. A woman may undergo an emergency Caesarean section because her baby is in distress, suffer a bladder injury related to scarring from previous surgery, and need repair by a urologist, only to find that her claim is denied because the policy covers bladder or bowel injury only in the context of vaginal delivery. Yet such injuries are extremely rare in vaginal births and are far more likely to arise during difficult emergency Caesarean sections, especially where there is scarring from previous surgery.
Health insurance should not reward consumers only when there is delay in treatment, more radical surgery or worse outcomes. Definitions and exclusions that do not reflect modern care should be updated and stated plainly so that consumers understand what they are truly buying.
Tan Eng Loy (Dr)