Cut costs by letting clinics e-file for insurance

Last Thursday's report ("New B1 insurance plan fails to address some concerns") highlights some of the inadequacies of an attempt to standardise Integrated Plans (IP) beyond MediShield Life to make them affordable.

But there are other significant shortcomings in the way the Ministry of Health (MOH) enforces e-filing for insurance claims for MediShield Life-linked IPs.

Let me highlight one anomaly.

Currently, only hospitals are authorised by MOH to do e-filing for insurance claims on behalf of patients. Specialist clinics in private hospitals, with their own in-house facilities for day surgery, are not equipped to do this.

So, if a patient at a specialist clinic wants to claim insurance for a day surgery procedure, he has to switch to the private hospital's surgical facility, causing costs to almost double.

Day surgery, which is recognised as a very effective cost-control measure, is increasingly adopted by various specialist providers.

The solution is for MOH to equip specialist clinics in private medical centres with e-filing capability.

Otherwise, for patients to make their insurance coverage meaningful, they would have to resort to using the more expensive option of having the specialist do the day surgery at the hospital.

This is a simple way to keep healthcare costs reasonable.

What is keeping MOH from allowing private specialist clinics to do e-filing? And why are insurers prohibited from processing, or are allowed to refuse, claims without e-filing?

Thomas Lee Hock Seng (Dr)

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A version of this article appeared in the print edition of The Straits Times on March 23, 2016, with the headline Cut costs by letting clinics e-file for insurance. Subscribe