What’s in a cataract operation?

I’m thinking whether I should create a small section call ‘Helping the Parent Retire’ or ‘The Parents’ Retirement’ to pen down some thoughts I have and any work/research I have done, but it may look strange next to the main categories and it doesn’t really fall into place nicely as a sub-category. Haha.

Anyway, my Pa recently realised he has cataract so he got a namecard from a fellow colleague who did his operation with Dr Jon Goh at The Lasik Surgery Clinic Singapore at a good price of $3,000 plus so I tried to make an appointment but was told Dr Jon Goh is no longer working at LSC. And the nurse recommended another Dr. In a summary, the services were really quite unprofessional. We were also quoted $5K. The person attending to us shared that there is indeed a price hike from last year to this. But $3,000 plus to $5,000, nice. The nurses are decently nice people but based on the encounter, I know the doc and the nurses are really not that professional, especially in comparison to the services I received in Shinagawa for my own lasik surgery 3 years back. Anyway, it was still very early stage for my Pa so we have a few months to await the cataract to better formed before the surgery can take place.

I came home, felt ill at ease and didn’t sleep well that night. Throughout the next few days, I called up Shinagawa and my Pa’s health insurer, NTUC Income and go through MOH/CPF Medisave website to check on the final costs and try to understand even more.

First thing I found out is, we had a very bad misunderstooding on the price. The fee quoted is for per eye, yes, not for both eyes. Although this article is quite outdated, it provides a good overview of the prices, I am sure there will be price adjustment upwards to account for inflation. At Singapore National Eyecare Centre (SNEC), one who gets a recommendation from polyclinics and do not choose a doctor (i.e. subsidised), per eye is about $1,300. If no recommendation i.e. private, it will range from mid $2,000 to mid $3,000. In NUH, it starts from $3,600. Based on the article, these are procedures using the standard len.

Secondly, my Pa is on NTUC Income Incomeshield Plan B, although my Pa is lowly educated (in the formal schooling sense), he had the responsibility to buy this plan for himself in his late 30s. I called up NTUC Income to check and found out that a claim can be made only if the hospital / clinic (participating in the Medishield scheme, I checked here for NTUC Income) e-file the claim for us. The LSC nurses were not very sure about this at all. In contrast, the Shinagawa lady, Pauline, made an effort to call me back after the clinic closing hours and explained the cost estimates involved, how they had already done claims via e-filing, and even went on to calculate the estimated cost together with me after the CPF Medisave Account (MA) deduction. This is what I call professional. So, I came out with this table below on my own after getting my understanding right:

Cataract Surgery Fee

I worked on the assumption that the cataract surgery will be a 4A surgical type (you can check on MOH website for this). The surgical table type will determine the insurance claim limit and CPF MA withdrawal. If you refer to the link, a cataract surgery can range from 4A to 6B but I just worked with 4A as the assumption for now. This means a claim limit of $3,000 and CPF MA withdrawal limit of $2,150, on per eye basis.

The surgery will cost $4,000 per eye for use of a standard len implant, and up to $6,000 per eye for a multifocal len, we are likely to opt for the former. Note that cataract surgery are performed one eye each time, about 1-2 weeks apart. In other words, there will be two day surgeries. For the first eye surgery, based on the deductible portion of the Incomeshield plan and the 10% co-payment, the insurance claim is about $450. Coupled with the CPF MA withdrawal of $2,150, we expect a cash top up $1,400. As for the second eye surgery, there is no longer the deductible portion (as long as operation is within the same policy year), so the claim is about $2,700, the remaining $1,300 will be paid off with my Pa’s CPF MA. Hence, CPF MA will pay $3,450 for the bill, while we will have a cash outlay of about $1,400.

Note that my family is not well to do, my Pa has been a driver since I was born. My Ma is an everyday housewife. We are really the HDB heartlanders you see around.

You may question, why then didn’t we consider a subsidised surgery in SNEC? There will be no cash outlay and my Pa’s CPF MA can be better preserved (we do see CPF MA money as our own for your info). I did toy with this option too, but my Pa is generally a lot more comfortable with the idea of going private for his eyes (he intends to continue working after all and he drives for a living). Considering this is within our spending means, $1,000 to $2,000 cash is a comfortable range, I would rather give him the peace of mind. I feel that it is important that the patient himself feels adequately comfortable.

The financial/insurance products’ savvy folks may then ask, isn’t there a mismatch of his insurance coverage and his medical needs then? He is on a basic Plan B, meant for restructured hospital ward B1/2, yet he is considering a private hospital/clinic treatment? There is some truth in this, but I am a believer of balance. For long term treatment or hospitalisation, my Pa is comfortable with a B1 ward, it’s a four bedder, and so far the newer ones are all air conditioned equipped. If he had opted for the Private Plan A, my Pa’s CPF MA would have been drawn down by an additional $6,600 (without considering the yearly 4% interest the CPF MA was getting).As for the add-on rider consideration, that will be discussion for another day, I have my own take on this as well.

Meanwhile I’m happy that my Pa can choose his desired treatment and feel more secure, security is a big issue at 58 years old! Just a few minutes ago, my Ma came into my room and exclaimed that her Pasar friend is going for cataract surgery at Gleneagles Hospital for a whooping $15,000! Her son who is apparently a businessman, will be able to afford to pay for the entire operation in cash. I wonder why wasn’t there even a basic healthcare plan for her, but I guess since it sounds like they can afford it, it’s fine. For the rest of us, it is still about a balance of healthcare needs, a decent coverage and of course some basic savings.

Does anyone has experience with SNEC or other good clinics, maybe you can share it with me? I would like to gather as much information on this because I was quite lost on this topic in the beginning, and with all our parents aging and cataract being a very common issue amongst the elderly, it is really for us to understand better.