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Singapore Law Watch
3 days ago
- Health
- Singapore Law Watch
Some good may come out of uproar over health insurance pre-authorisation: Opinion
Some good may come out of uproar over health insurance pre-authorisation: Opinion Source: Straits Times Article Date: 24 Jun 2025 Author: Salma Khalik Great Eastern's move to suspend issuing of certificates for admission to Mount Elizabeth hospitals has created an opportunity to sort out sources of rising healthcare costs. Great Eastern has decided to suspend pre-authorisation of treatments for policyholders using Mount Elizabeth Hospital (MEH) and Mount Elizabeth Novena Hospital (MNH). The reactions seem to have been a bit over the top when, in fact, the move could pave the way for much-needed discussion on healthcare costs. Some doctors and patients have claimed that GE's move restricts their choices, despite the high premiums they pay for treatment at private hospitals. Even the Ministry of Health (MOH) has chipped in to say that it is engaging GE to better understand the impact of its decision. But let's be clear. GE's decision to stop pre-authorising treatments does not mean that the insurer will stop covering patients who choose to get treatment at these hospitals. It merely means that it is not giving blanket approval for those treatments, but rather, will reimburse valid claims when they are submitted. So patients are still free to choose whichever hospital they prefer. It's not even the case that GE has done something unprecedented. In fact, two of the seven insurers offering Integrated Shield Plans (IPs) – Income and Singlife – do not pre-authorise treatments for policyholders. So why the disquiet over GE's move? One reason is that many are reacting without fully understanding the situation on the ground. Another is possibly because GE's move affects only two private hospitals, which it claims are significantly more expensive than the rest. First, let's look at what pre-authorisation serves. The practice surfaced here less than a decade ago, following recommendations in 2016 by the Health Insurance Task Force. Pre-authorising a treatment lets insurers assess the cost and medical necessity of treatments before they are carried out; it gives patients peace of mind knowing their treatment will be covered; and it offers greater clarity to hospitals and doctors on insurance coverage. In 2019, Life Insurance Association Singapore came up with a standard form for the pre-authorisation of hospital and surgical bills. It is also worth noting that pre-authorisation is different from getting a letter of guarantee (LOG), where the insurer tells the hospital it promises to pay the full, partial or a set amount for the treatment of its policyholders. Having an LOG means patients will not need to place a deposit on admission. GE has assured that the two hospitals can still request electronic letters of guarantee for their patients, 'ensuring that there is no upfront cash deposit of up to $50,000'. Reasons behind the move So if GE is willing to provide LOGs, why stop pre-authorisation? One reason could be that GE wants to steer its policyholders towards the other seven private hospitals where total bills tend to be lower. The insurer said it has been tracking bills for procedures done at MEH and MNH and found that, for similar procedures, the charges are typically 20 per cent to 30 per cent higher than at other private hospitals. Perhaps GE hopes that the fear of losing patients might lead the two hospitals to lower their total bill sizes. The move also gives GE more wiggle room, when disputing claims. The Straits Times understands that often, in applying for pre-authorisation, hospitals just give a broad estimate of the potential charges. It is only when claims are made that a breakdown surfaces. But having pre-authorised the treatment makes it difficult for insurers to dispute the claim. Pre-authorisation, after all, is meant to give patients peace of mind and the assurance that their bill will be paid. Although Mr Yong Yih Ming, chief operating officer of IHH Healthcare Singapore, said that there are occasions where insurers may still dispute claims despite pre-authorisation, insurers enter these negotiations at a disadvantage if they had given prior approval. Without it, they can more easily scrutinise bills and query charges that appear higher than the norm. GE told The Straits Times: 'In the last few years we have 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 GE spokesman added that the higher total bills arise not because doctors at these hospitals are charging higher fees, but rather because of charges by the hospital, such as for the use of its operating theatres and wards, as well as for consumables. He said: 'Doctor fees are unlikely to be the cause for the increase in the total bill size as it is consistent across the board and benchmarked to MOH fees benchmark. We have observed that the same doctors providing the same treatment at different hospitals can result in different bill sizes, which could imply that it is resulting from hospital charges.' Another major IP provider, Prudential Singapore, gave similar views: 'Generally, private hospital charges are higher than public hospitals. At the same time, we also observe that the median claim costs at certain private hospitals are higher than others for similar procedures.' It, too, tries to steer policyholders to certain hospitals and doctors by offering no claims-based increase in premiums for riders for those who choose one of the 1,700 specialists (including all in the public sector) on its panels, and have the procedure done at its partner hospitals in the private sector, which does not include any IHH hospital. What happens next? Associate Professor Jeremy Lim of the Saw Swee Hock School of Public Health said he was disappointed by GE's move, as 'unilateral, arbitrary decisions announced at short notice' are unhelpful. He said: 'Payers and providers are mutually dependent and work in a partnership of mutual respect and open communication. Without private providers, there would be no need for private health insurance, and without private health insurance, many of us would not be able to afford private healthcare.' However, in fairness to GE, Prof Lim added that it's understandable that the payer – in this case, the insurer – seeks to maximise the value of the money it pays out. He said: 'Whilst doctors' fees have been moderated as a share of total bill size, facility fees have escalated. Every effort should be made to manage down this portion of the fees.' According to both GE and IHH Healthcare Singapore, which owns four private hospitals here including MEH and MNH, the two parties have been in discussion for some months. Where they differ is that IHH said it had been given no inkling of GE's move, while GE said it had informed IHH of its decision and rationale. Perhaps GE moving so quickly to cut off pre-authorisation could have been handled better. On the other hand, if it manages to get the two hospitals to align their charges with others in the private sector, it can only be a good thing for patients, while moderating overall healthcare costs. Now that the problem has been spelt out and made the headlines, perhaps MOH should engage not just GE, but also all the IP insurers as well as private hospitals in a discussion on their charges. IHH would then have the opportunity to either show that the charges at the two hospitals are not excessive, or justify why they are. If it can't do this, it may have to rein in the charges. Escalating healthcare cost is a major concern, and the current brouhaha opens the way to possibly nipping some of the push factors in the bud. Salma Khalik has been covering health issues for over 20 years. Source: The Straits Times © SPH Media Limited. Permission required for reproduction. Print
Straits Times
19-06-2025
- Health
- Straits Times
MOH engaging Great Eastern to better understand suspension of Mount Elizabeth pre-authorisation
GE's rationale was that high costs from the two named hospitals were the reason for this decision. PHOTO: ST FILE 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 the Mount Elizabeth hospitals. In its reply to queries from the media, MOH said Integrated Shield Plans (IPs) 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 from June 17 for policyholders admitted to Mount Elizabeth and Mount Elizabeth Novena hospitals. Its rationale was that high costs from the two named 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 the decision was not a reflection of their clinical quality, but 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. 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.' The Straits Times has reached out to both GE and IHH Healthcare , which owns the Mount Elizabeth hospitals. Join ST's WhatsApp Channel and get the latest news and must-reads.
Straits Times
27-05-2025
- Health
- Straits Times
Forum: Providing medical concierge services may not address patients' needs
A recent Opinion piece on healthcare costs (Some practical ways to rein in rising healthcare costs, premiums, May 21) mentioned how insurers can provide medical concierge services to direct patients to specialist doctors, based on their Integrated Shield Plans. As a general practitioner (GP) since 1985, I have always referred my patients to specialists within their budget who I personally know have the skill sets that are relevant to their specific medical issues. For example, I would refer a young female patient with an enlarged thyroid gland to a surgeon I know is specially noted for neat, fine scars. A young man likely to need prostate surgery for possible cancer would be sent to a urologist I know is exceptionally careful about conserving urinary continence and erectile function. And I would send a patient with recurring bladder cancer to a hospital with a large multidisciplinary urology department – because I foresee that the patient will eventually need care available in an integrated group. All this care in matching patients' needs with surgeons' skill sets can be wiped out by medical concierges referring patients to other specialists – with choices based on 'lower charges'. Of course, it can be said that all general surgeons can do thyroid surgery competently, or all urologists can do a prostatectomy competently upon completing their specialist training. But while all surgeons and all hospitals are competent, some are exceptional, and this matters in more complex cases. That is why many GPs try to match an individual patient's medical needs to doctors with specific skill sets. In contrast, a medical concierge could simply locate another specialist who could be charging less and shunt the patient there, indifferent that the patient could have had a better outcome with the original specialist. Is this acceptable? Dr Lee Pheng Soon Former president of the Singapore Medical Association More on this Topic Forum: What readers are saying Join ST's Telegram channel and get the latest breaking news delivered to you.
Straits Times
23-04-2025
- Business
- Straits Times
Forum: Financial advisers must adhere to high ethical standards and industry regulations
Forum: Financial advisers must adhere to high ethical standards and industry regulations We thank Dr Tan Yia Swam for her letter 'Insurance agents asking doctors to change codes to ensure claims go through' (April 17) and refer to the Ministry of Health's reply 'MOH will review MediShield Life coverage for prophylactic mastectomy' ( April 22). We would like to provide more context regarding Integrated Shield Plans (IPs), preventive treatments and ethical guidelines for financial adviser representatives. IPs offer coverage for hospitalisation, surgery and selected outpatient treatments on top of MediShield Life coverage. As IPs are today designed to cover medically necessary treatments, treatments and procedures that are preventive in nature are not claimable. IP insurers are constantly seeking ways to balance the scope of coverage with premium affordability and sustainability for policyholders. Benefits and coverages are reviewed from time to time, taking into consideration advancements in clinical practice and medical science. We note that the Ministry of Health is undertaking a review of the matter. IP insurers will review the scope of IP coverage accordingly. Financial adviser representatives play a key role in providing advice to their clients on insurance products, including IPs, and must adhere to high ethical standards and industry regulations. If consumers or healthcare practitioners encounter potential misconduct, including being pressured to misrepresent medical codes for claims, they should provide the details to the relevant insurers for further investigation and action. We recognise the complexity of the situation and good intentions of all parties involved. The life insurance industry is committed to working closely with all relevant stakeholders to best address the needs of policyholders equitably. Chan Wai Kit Executive Director Life Insurance Association, Singapore More on this Topic Forum: What readers are saying Join ST's Telegram channel and get the latest breaking news delivered to you.
