MOH engaging insurer to better understand suspension of Mount Elizabeth pre-authorisation
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GE's rationale was that high costs from the two named hospitals were the reason for this decision.
PHOTO: ST FILE
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SINGAPORE – The Ministry of Health (MOH) is engaging insurance group Great Eastern (GE) to better understand the impact of its decision to suspend pre-authorisation certificates for Mount Elizabeth hospitals.
In its reply to queries from the media, MOH said Integrated Shield Plan (IP) insurers “would have to ensure that policyholders continue to be able to access the full benefits of their policies in accordance with the terms and conditions for claims, as stated in their policy contracts”.
GE, in a message to its panel doctors earlier this week, said it has temporarily stopped issuing pre-authorisation certificates
The insurer had said that high costs from the two hospitals, compared with other private hospitals, were the reason for this decision.
Pre-authorisation confirms that the insurer has approved the medical treatment, including the costs, before the treatment begins.
GE told its panel doctors that the decision was not a reflection of their clinical quality, but that the insurer was “prioritising facilities that deliver the same high-quality care with greater cost transparency and cost-effectiveness”.
The decision took both the hospitals and GE policyholders by surprise.
In its e-mail to the media, MOH said the ability to afford major medical expenses is understandably a concern for Singaporeans and that all Singaporeans are covered by MediShield Life, which is sized to provide coverage for large subsidised bills.
“Singaporeans may opt to purchase IPs or additional coverage,” MOH said.
“As these are commercial products, while MOH regulates the key parameters of IPs for financial sustainability, individual insurers’ changes to administrative processes such as pre-authorisation framework and partnerships with private providers are based on their commercial and actuarial considerations.”
Responding to queries from The Straits Times, a GE spokesperson said the insurer “continues to be in active discussions with the hospital group involved and also the Ministry of Health on this topic”.
He added: “Great Eastern remains committed to simplifying our customers’ healthcare journey by providing clear guidance and assistance at every step of the way. These efforts are part of our responsibility to keep protection accessible and sustainable for everyone.”
In the last few years, GE “has observed that certain private hospitals have been charging significantly more than others for the same treatment, same clinical outcome, similar level of complexity, as well as for procedures that are less complex”.
“The cost difference in total bill size typically ranges between 20 per cent and 30 per cent, but can sometimes go higher in some cases. Since pre-authorisation certificates confirm coverage and guarantees the claims before admission, Great Eastern is temporarily pausing these for the specified hospitals, as this helps us address the issue of rising charges from the two hospitals,” the spokesperson added.
According to GE, the temporary suspension does not impact the coverage or benefits for its policyholders.
“For planned procedures or surgeries, the two hospitals can still issue an eLOG (letter of guarantee) and e-file the claims to Great Eastern, where the claims will be assessed according to the terms and conditions of their policy, and all eligible and covered claims will be paid,” the spokesperson explained.
