• Aviva reversed its move to stop diagnostic endoscopies coverage under its Integrated Shield Plans
• It will initiate revised claim settlements for such endoscopy claims that were rejected between March and August 2020
• Doctors had raised concerns about the dangers of removing coverage of diagnostic endoscopies

SINGAPORE — Insurance firm Aviva has made a U-turn on its move to stop coverage of diagnostic endoscopies under its Integrated Shield Plans (IP), after doctors raised concerns.

The insurer has reinstated its coverage of diagnostic endoscopies since August and will be “initiating revised claim settlements” for such endoscopy claims that were rejected between March and August this year, its spokesperson said in a statement on Friday (Sept 4).

IPs are health insurance policies that have two components: One administered by insurance agencies to provide extra coverage for private hospitals and higher ward classes; the other where policyholders may opt for subsidised services under the national Central Provident Fund's MediShield Life insurance scheme, if eligible.

Diagnostic endoscopies are used by doctors to take a look at a patient's internal organs by inserting a long, tube-like instrument with a camera and light. The procedure is used to look out for signs of serious illness, such as cancers, ulcers or other abnormal tissues.

In announcing its initial decision to stop coverage of diagnostic endoscopies, Aviva had sent a letter to doctors on March 16, stating that there had been instances of doctors “over-servicing” patients.

This could drive up costs for policyholders, Aviva said, which was why it decided to tighten its regulations for diagnostic procedures.

One example Aviva gave was a policyholder who made claims for 12 nose scopes in a single year “without clear medical need”. It also said that there were “patients who were admitted for gastritis or piles and then referred to many other specialities… for additional scans and tests”.

DOCTORS TELL OF PATIENTS' REJECTED CLAIMS

Doctors approached by TODAY said that they had patients who had been unsuccessful with claiming medical costs of diagnostic endoscopy if there were no medical issues found after the scope, or if Aviva determined that the doctor did not conduct treatment before deciding a diagnostic endoscopy was necessary.

Dr Ng Chee Yung, president of the Society of Colorectal Surgeons Singapore, said that he has had patients who were denied claims, and opted to pay out of pocket, and he has helped to reduce their fees.

He insisted that the rollback by Aviva was “unfair” because their policyholders thought that they had been paying for “full and comprehensive coverage”, and were in a position where it was difficult to switch insurers if they had pre-existing conditions.

Dr Chua Tju Siang, president of the Gastroenterological Society of Singapore, said that at least three of his patients who are Aviva policyholders had declined a diagnostic endoscopy in August before the company made its announcement.

Colorectal surgeon Ho Kok Sun recounted the difficulties his patient, an Aviva policyholder in her 50s, faced when she tried claiming for an endoscopy. He had performed a diagnostic endoscopy after her general practitioner recommended it when her symptoms persisted for more than four months despite treatment.

However, her claims were rejected on the basis that Dr Ho had not provided treatment before conducting the endoscopy and that they were not able to discover anything conclusive from the procedure.

In a letter to The Straits Times Forum on Aug 29, Dr Ng Chee Kwan, vice-president of the Singapore Medical Association (SMA), raised concerns about some insurers’ move to reject patients' claims for diagnosis endoscopy.

Dr Ng said that SMA was “concerned that denial of coverage for diagnostic endoscopy may lead to patients not going for the procedure, leading to delay in diagnosis and worsening of the condition”. It is also worried that insurers may adopt a similar stance towards other diagnostic procedures in the future.

Dr Tan Wu Meng, Member of Parliament for Jurong Group Representation Constituency, also mentioned in Parliament on Sept 1 that disallowing claims for diagnostic endoscopies is a “ serious development with implications for patient care and patient safety”, as he called on the Ministry of Health (MOH) to look into this.

AVIVA’S U-TURN

In an email to Aviva’s financial advisers seen by TODAY on Friday, the insurer said that customers who are eligible for a revised settlement will be contacted by end-September.

However, it also said that “other standalone diagnostics that are not associated with inpatient treatment or hospitalisation will continue to be excluded from coverage”. These include X-rays and magnetic resonance imaging (MRI) procedures.

TODAY understands that this is also the practice of some of the other insurers.

Dr Ng of SMA applauded Aviva’s move to reverse its position.

“We hope that both doctors and insurers will continue to work together for the well-being of our patients,” he said.

In response to the issue, MOH said in a statement on Friday that procedures such as diagnostic scopes are covered under MediShield Life, subject to the prevailing claim limits, deductibles and co-payment rates.

It urged doctors to continue prescribing diagnostic scopes if the patient’s condition called for it, and advised patients not to avoid endoscopies when prescribed by their doctors.

MOH also encouraged insurers and clinicians to work closely to review policies to ensure that they “encourage appropriate medical diagnosis and care, and are beneficial for policyholders”.

The Life Insurance Association said in a statement on Friday that diagnostic endoscopies are covered by IPs when medically necessary, and that only “one of its seven insurers” had stricter rules with its claims but has “since aligned its practices with prevailing industry norms”.

The association also emphasised that IPs cover surgeries conducted in day-surgery centres and private clinics as long as they are covered by MediShield Life.

“However, if the patient’s medical condition is one that can be treated in an outpatient, or day surgery, setting, but the patient chooses to be admitted to the hospital for the procedure, the insurer would not be able to cover the room and board, and other incremental charges arising from the hospitalisation,” it said.

“Most IPs provide pre-hospitalisation benefits that cover medically necessary outpatient diagnostics, such as X-rays, MRI or laboratory tests, provided the patient subsequently requires medical or surgical treatment in a hospital.

“For peace of mind, we recommend that policyholders make use of their IP insurer’s pre-authorisation service, if available, to confirm coverage before undergoing a planned day surgery or hospitalisation.”