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General Practitioner, Specialist and Alternative medicine: how to differentiate them?

02 May 2018

You want to see a cardiologist but don’t know what are the steps to be able to see him? While being reimbursed by your insurance? Here is an article that will help answer all of your questions on General Practitioner, Specialist and Alternative medicine.

1) Definitions of General Practitioner, Specialist and Alternative medicine

A General Practitioner or GP is a doctor who does not specialize in one particular area of medicine. You generally go see him in case of any common illness or in case of routine checks.

Specialists are healthcare professionals who has specialized and practices in only one particular area. Cardiology, neurology and dermatology are a few examples of specialities. Here is a list of recognized specialists in Singapore. However, each insurance company has a list of specialities that they recognize and for which you can ask for a claim. Here is AXA’s list.

Alternative medicine is a type of practices that are used instead of traditional therapies. Alternative treatments can be a complement of standard medicine. It can be Osteopath, Acupuncture, Homeopathy, etc…

2) How does it work at UEX?

The 4 types of plans at UEX cover you differently. Be sure to choose your contract according to your needs. Here is the different coverages for GP, Specialist and Alternative Medicine:

A) General Practitioner or GP

Let’s suppose that you are insured by UEX with a Base Plan 1 or a Base Plan 2. You go to see a GP within the AXA panel. In that case, all you have to do to access direct-billing is to show your insured card. Indeed, this means that you will not pay the fees for your consultation and your medication.

If you decide to see a GP that is not included in the AXA panel, the fees are as followed:

For Base Plan 3 and 4, the reimbursement is up to the annual limit. This limit is:

This means that when you can go see a GP, you will be reimbursed. You can’t go over the annual limit, which also includes consultations to specialists and alternative treatments. For these two plans, for the reimbursement to occur, General Practitioners do not need to be mentioned in the AXA panel. However, there is also a panel in which you can go to benefit from direct billing for General Practitioners and Specialist.

B) Specialist

Here is the reimbursement at UEX for a specialist consultation:

Just for you to have an idea of the prices, a dermatology consultation at National Skin Center costs S$120.

However, if you are insured with Base  Plan 1 or 2, you need a letter of referral from a GP. Without it, the reimbursement of your consultation at a specialist will not occur.

Be careful not to mix up your specialist’s consultation and a diagnostic tests that he prescribes. The latter are not taken into account in the reimbursement of the consultation with a specialist. Diagnostic tests are MRI, X ray, CT scan, blood test, etc… However, please note that the reimbursement is separate from the consultations. 

Here is the reimbursement at UEX for a diagnostic test:

Don’t forget to take into account that these tests must be prescribed by a specialist. However, if a diagnostic test is prescribed prior to a hospitalisation, then the test will be taken into account in your inpatient limits.

Pediatrician are considered as specialists. For children under 36 months insured with Base  Plan 1 and 2, they can go to a pediatrician without a referral letter. However, some General Practitioners specialize in the healthcare for children. Therefore, A consultation to this type of GP could replace a consultation to a pediatrician. This can help avoid going to the pediatrician when they are a bit older. It can be a good alternative considering the prices of a consultation to a pediatrician, which cost generally around S$120.

At UEX, this is the coverages for pediatricians:

 

Furthermore, dental and optical are as specialists. They are options you can add when you subscribe or renew your contract.

C) Alternative medicine

At UEX, this is the coverages for any alternative treatments: 

For Physiotherapy, things work a bit differently in certain cases. If, following a hospitalisation, you have been prescribed some physiotherapy by your surgeon, then this will be covered according to your inpatient coverage. However, you can decide to go have a physiotherapy session without a prescription. Therefore, your plan’s coverage for alternative medicine will apply.

3) Procedure: how to be sure to be reimbursed after a consultation?

Each insurance company’s procedure changes one from the other. Be sure to check how it works for you. Here is the procedure for UEX:

A) For Base Plan 1 and 2:
    1. Go see your General Practitioner. We highly recommend you go to a doctor included in the AXA panel. In that case, direct-billing can then apply. However, if you decide to seek medical care from a doctor outside the panel, you will have to pay for your fees and then claim for your reimbursement.
    2. The GP will give you a referral letter.
    3. With this letter, head to see any specialist. You must pay your consultation and then claim to AXA. The reimbursement is according to your plan.

For the reimbursement of your medical diagnostic, a specialist needs to be prescribe them. For example, if your GP prescribes a blood test, AXA  will not proceed to your reimbursement. In that case, you should first see a specialist. However, if the latter prescribes the blood test, you can do it and be reimbursed.

This process is to avoid abuse. Furthermore, the premium prices are more advantageous thanks to these restrictions.

For you to understand everything, we’ve built an infographic for you that explains everything:

GP, Specialist, Infographic how to understand everything in base plan 1 ans 2

B) For Base Plan 3 & 4

The Base Plan 3 & 4 takes into account the annual limit of the coverage for GP and specialist. You have no individual limit for both. Furthermore, there is a panel for GP and Specialists. Therefore, you do not need to pay your medical expenses when you go to one of the doctor’s. You will still need to pay and claim for doctors that are not in the panel.

In most cases, you do not need a referral letter to see a specialist or undergo medical diagnostic. However, some medical examinations like colonoscopies require the authorization of AXA.

Useful tip: people insured with Base Plan 3 and 4 do not need to see a specialist for a blood test.

Now you have all the cards in hands to choose between GP & Specialists. Try going to a doctor from AXA”s panel. You will benefit from direct billing and get your expenses 100% covered.

To find out more about healthcare topics in Singapore you can check our articles. To understand how your health insurance plans cover the healthcare costs, you can approach UEX’s happiness team by email or by phone for more information and guidance – and the good news is that they are super nice!

With UEX, you can obtain a quote for a health insurance contract customized to your needs and requirements – all in less than a minute!


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