My husband was stricken with acute abdominal pain on Jan 19. As it was early, the
neighbourhood clinics were closed and we went to Mount Alvernia Hospital’s 24-hour clinic for his
treatment.

The staff acted quickly and tests revealed that he was suffering from a stone in his ureter. The
next step was for the hospital to refer us to a urologist for urgent follow-up treatment.
We were told that the hospital could not refer my husband to a specialist urologist as his medical
insurance plan under Aviva did not allow it. We were advised to visit our general practitioner who
is on the panel of Aviva doctors, to secure a referral.

Thus, we had no choice but to make the additional trip to the GP. But the GP also had difficulty
finding an appropriate urologist as the panel of doctors under the Aviva plan did not include
urologists. After several calls to surgeons and doctors on the list, we were referred to Singapore
General Hospital’s Urology Centre. The same day, my husband saw the specialist and received
treatment.

We are grateful to the doctors and nurses at Mount Alvernia, the Healthway Toa Payoh Clinic and
the team at the Urology Centre for their efficient response. However, the same cannot be said of
my insurer.

In an urgent situation, where immediate medical attention is needed and the GP’s clinic is closed,
it is only logical to seek treatment at the nearest hospital emergency room. Ironically, Mount
Alvernia’s 24-hour clinic is listed as a source of co-pay treatment under the Aviva panel. So I fail
to understand why Aviva did not allow a referral from the hospital clinic and insisted on a GP
referral. This is inefficient as the hospital is in a better position to run investigative tests,
shortening turnaround time to seek treatment.

This incident highlights the limitations of medical co-payment insurance schemes. Companies
may buy such schemes for their employees as a cost- effective employee benefit.

But companies should also discern which insurance companies provide better value in terms of
service and care, should their employees need it. An insurance plan that gives someone in acute
pain the runaround is neither good value nor good service.
Source:
4 February 2009
Patricia Koh
The Straits Times

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