Medical Bills

This article was written in 2011, Singapore. It may not be relevant to you now but serves as a guide on what to expect.

I’m sure this is the first thought that most dads will have upon hearing they’re gonna have multiples. But can you imagine, given the limited population in Singapore, how many triplets can occur in this tiny island? Who can we turn to for advice on local medical expenses? Well, the answer is “zero”, nobody. We checked multiple forums, but under the threads for multiples, there were only a few pathetic entries and almost all are twins parents. Sign…the complication, risks, and medical expenses for higher order multiples pregnancy is way way way above singleton or twins.

HIGH COST!

As quoted from Dr Heng from Parkway Private Hospital, who helped us with fertility treatment, “GET PREPARED FOR S$100K PER BABY“. Many were shocked and couldn’t believe it. “But the private ward charges are ok, and comparable to restructured hospitals, so how can it amount to $100k per baby?” Let me explain further on the “hidden cost”.

• Beside the mummy’s ward charges, babies who require additional NICU/special care unit will cost a bomb.

• Triplets or higher order multiples will be born pre-term. Count yourself lucky if you pull through to 34-35 week, but most of the triplets are born prior to 30 week. The earlier babies are born, the longer they’re required to stay in NICU, sometimes for mths.

• Triplets C-section delivery require at least 3 pediatricians, a team of obstetricians who expertise in high-risk pregnancy, a huge team of experienced mid-wife/nurses. Can you imagine the cost involved for engaging these experts at “private rate”?

• Ok, treatment cost at the NICU (oxygen mask, medication, scans, etc) will be at “private rate” too. What if babies need additional surgeries?

• Lastly, how about the extensive weekly prenatal consultations, scans, monitoring, hospitalization, injection, medication, etc etc?

So what should we do? Our private doctor’s advice was: “Buy Insurance”, and she threw a prudential brochure to us. So…we called the agent and…WE WERE REJECTED BY THE INSURANCE…as we’ve triplets. So, we came to a dead end. If we stay with the private hospital, we’ll be in debts for many years. With no choice and no people to turn to for advice, we were like the blind.

WHICH HOSPITAL?

Which way should we go?

Shall we switch from private to government/restructured hospital? If so, which restructured hospital? Which doctor? Which class of ward? So many questions yet so little resources and people with past experiences whom we can consult.

Thanks to a blessing in disguise, I was so sick and dehydrated during my 1st trimester that I needed hospitalization badly. The private doctor said it’s very expensive to be warded and could only provide a 1 hr drip on a small bed in her clinic. It was really quite pathetic. So we asked her if there’s any more emergency, what should we do? She said “GO TO KKH“. After a few days my conditions worsen and hubby fetched me to KKH A&E without second thought. So that’s how we ended up in KKH.

Yes, there are many complaints that the waiting time is very long in KKH A&E, but for my case, they let me rest on a bed in their monitoring room while waiting for my turn and place me under 1st priority. There are even free apples to fill our empty stomachs while waiting. And it was like close to midnight. We were so touched. “Ok, don’t worry, you need a drip and a jab to stop your morning sickness, we’ll arrange for hospitalization.” No questions asked on whether we can afford or not, as we can always opt for subsidized ward. (YEAH!!)

Many peers of our generation prefer private hospital as KKH is where our moms went to in the past. Ask any elderly moms out there and she’ll complain that the nurses were very fierce, service and facilities were so-so, and a whole lots of horror stories, etc.

Hmm…so if you’re earning a decent income and can afford delivery in private hospital, why not? Further more, KKH “private suite” charges the same or sometime higher amount. However with triplets, it’s a totally different story. And so, we switched to KKH.

But the reasons we switched is not merely because of the cost. It’s the huge amount of expertise, resources and facilities all within 1 hospital, dedicated for women (especially pregnancy), that changes our minds. There are so many doctors, nurses, experts around, I feel so safe, protected and well-taken care of.

And KKH is no longer the old haunted house look-alike hospital your mom remember. The new KKH looks like a space ship! Isn’t it cool?!

Opt for the “private suite” follow up and a dedicated doctor (whom you requested for, experience in multiples pregnancies) will follow you throughout the pregnancy. You will find yourself in a lounge-like private suite with free coffee/milo and apples…so much better than my previous private doctor’s small, pathetic and cramp clinic.

For multiples pregnancy, you may also consider NUH or SGH for subsidized rate. Since you’ll need extensive follow up and weekly consultations/scans, location should be a prime decisive factor too. Ultimately, do consider that KKH manages numerous high risk and complicated pregnancies referred from other centres locally and abroad. It has the best neonatal outcomes in Singapore has the largest number of NICU/special care beds and private delivery rooms (this is crucial as critical multiples pregnancy cases will be warded here for close monitoring of the babies’ heart beats and contraction etc, I was warded in this type of room at week 30).

If you think you can always stick with your private doctor and only switch to KKH during emergency, please reconsider an earlier switch over (preferably in the 1st trimester), because:

• Priority (bed/NICU) will be given to existing patients

• Dangerous and hard to make prompt decision due to lack of prenatal records. Restructured hospital follows SOP and always record a lot of details (my case file is 2-3 inch thick). But private Dr may not do so and when we requested our private Dr to fax over existing records during my 1st KKH admission, it’s only 1 piece of hand-written paper. The nurse was so shocked and even asked me to check with the private Dr if their fax machine had broken down.

RESTRUCTURED HOSPITAL? ARE YOU SURE?

Many people thought that since they pay a premium price for private Dr, their services should be premium too. WRONG WRONG WRONG! Ok, if you’re still not convinced by my real life experience above, please consider this…you are only assigned to 1 private Dr. In cases of emergency, if he/she is not around, or unable to treat you for high risk issues (which is common for higher order pregnancies), what shall you do? Hmm…as what our previous private Dr advised, “GO TO KKH”.

Ok, if you wanna statistic, our previous private Dr seldom come across triplets case in years of practice, and was only handling 1 more triplets case during my pregnancy, I’m only her 3rd triplets case…whereas in KKH, they’re handling many triplets per year, for example, during my admission at week 30, there were another 2 triplets moms warded too. And recently I got to know this other KKH triplets mom-to-be who is also about the same gestation period as me.

Well, some hear horror story that they’ll be “pushed” from one department to the next, example from the Diagnostic Center (for scans) to the Dr’s clinic, to the pharmacy and you can spend hrs just for 1 appointment. But remember this, for multiples pregnancy, better equipment and more experienced Sonographers are required as it’s not an easy task to scan multiples accurately. And you will require bi-weekly or weekly scans to monitor babies’ growth and well-being. If you opt for “Private Suite”, the Dr also has the ultrasound machine in her room but she’ll still request for a more detailed scan from the Diagnostics center (I prefer that too). Everything under one roof, isn’t it better?

WHICH DOCTOR?

If you read my other blog entry, you might realize we also had trial and error in selecting the right doctor. We had 2 recommendations for KKH obstetricians: 1) Friends’ recommendation – a Senior Consultant who is experienced in fertility treatment, 2) Mom’s church sister’s (who’s a doctor too) recommendation – a Consultant who is an expert in handling twins & multiples. We thought the senior consultant will be better so we waited one month to see her, alas, she’s not suitable. Hmm, and we were referred by her to another doctor who coincidentally is the same doctor recommended by our mom’s church friend. We should have followed our mom’s recommendation in the 1st place…

So, this lovely, encouraging, experience, and gentle obstetrician, who is like an angel to us and help us to reach beyond national average gestation period is Dr June Tan. Without her, I won’t be able to have the courage to keep all 3 babies (opt out of selective reduction) and reach beyond week 34. Meeting the right Dr with the right vibes will not only give you positive energy, but also the positive outcome to your pregnancy.

DOWNGRADE FROM PRIVATE TO SUBSIDIZED WARD?

You may wonder, if you opt to be followed up by a dedicated Dr in the “private suite”, can you still opt for subsidized class during admission or delivery subsequently? YES YOU CAN. No worries, every admission will be deal with individually. Prior to each admission, you’ll be advised via “financial counseling” based on the 1)estimated bills according to your condition, 2)costs comparison among wards A-B1-B2-C, 3)amt that can be claimed from medisave. They’ll then advise you which ward to choose etc. Although the private Dr will not perform the delivery if you opt for subsidized ward…there’s still a team of highly qualified Dr experience in multiples birth to perform the C-section.

On the other hand, if your pregnancy went smoothly beyond the national average gestation period, babies are estimated to be over 2kg, so you opt for A or B1 private ward delivery package (as you wanna your Dr to deliver for you), but unfortunately, the babies are born with some issues and need extensive treatment (considered as high risk case), KKH can still downgrade you to subsidized ward so that babies hospitalization (neonatal charges such as NICU, treatments etc) will follow the subsidized rate too.

If you’re still worried on the cost, no worries, for restructured hospital, a team of medical social workers will assist you in the bill, it might be applying for additional grants, or implementing an installment plan, etc.

Hope that our experiences and the information we gathered along the way will be able to assist you. Mummy, we know it’s already very tough to handle the emotional and physical challenges for multiples pregnancy, so Daddy, please stop worrying on the costs by choosing the right hospital now. Get on your feet for your wife needs you more than ever and do stay positive to encourage her to go on and on. The more positive both of you are, the higher the chance you will have longer gestation period and thus healthier babies, and thus lower costs.