Great Eastern stops issuing pre-authorisation certificates for admission to Mount Elizabeth hospitals

SINGAPORE: Insurer Great Eastern from Tuesday (Jun 17) stopped issuing pre-authorisation certificates for policyholders admitted to Mount Elizabeth hospitals in Novena and Orchard.

According to a notice on its Health Connect website, it said such certificates will still be available for other hospitals and day surgery centres. 

Pre-authorisation refers to the insurer’s approval of coverage for medical costs before treatment. 

This minimises the upfront cash deposit needed for certain costs, such as hospitalisation and surgical expenses, doctors' fees, tests conducted in hospital, and certain outpatient treatments. The insurer settles these pre-approved expenses directly with the hospital.

It does not cover non-eligible medical expenses and other components, such as co-payment, according to a list of frequently asked questions on Great Eastern's website. 

Without pre-authorisation, patients may have to pay for their treatments first, before filing their insurance claims for assessment.

In response to CNA's queries, a spokesperson for Great Eastern said: "We have observed that, over the past few years, certain private hospitals have been charging significantly more for similar treatment."

The move is part of the company's "ongoing efforts to manage rising healthcare costs and ensure long-term affordability for all policyholders". 

"We want to assure our policyholders that there is no change to their coverage, and they can still receive treatment and submit claims as usual with no impact to their benefits," the spokesperson added.

For example, both hospitals can still issue electronic letters of guarantees or file claims to Great Eastern, where the claims will be assessed according to the terms and conditions of their policy. All eligible and covered claims will be paid, said the spokesperson.

Letters of guarantees can be requested when patients are unable to settle the pre-admission deposit for day surgery and inpatient hospital treatments. It can be used to waive the deposit for up to S$50,000 (US$38,900) in private hospitals.

Any pre-authorisation certificates issued before Jun 17 will be honoured, added the spokesperson. 

HEALTHCARE GROUP "SURPRISED"

The two Mount Elizabeth hospitals are part of IHH Healthcare Singapore, the largest private healthcare provider in the country.

Gleneagles Hospital and Parkway East Hospitals, also owned by the group, are not affected by the cessation of pre-authorisation certifications.

The suspension “surprised” IHH Healthcare Singapore, which has been in active discussion with Great Eastern over the past few months, the group’s chief operating officer and chief executive officer of Mount Elizabeth Hospital Mr Yong Yih Ming told CNA on Wednesday.

Mr Yong said: “We do not agree with GE's claim about higher prices at two of our hospitals for similar procedures and case profiles.

"Each of our hospitals has different focus and areas of excellence - Mount Elizabeth Hospital and Mount Elizabeth Novena Hospital house facilities and equipment that allow specialists to manage patients and perform surgeries that are not available at other hospitals.”

This is also why some of the more complex cases are managed at these two hospitals, he said.

Great Eastern policyholders who are undergoing medical care by specialists at the Mount Elizabeth hospitals, or have treatment records there, will continue to have cashless access to hospital admissions.

“This ensures that these patients do not need to worry about cash outlay for their treatment,” said Mr Yong.

“We are also working closely with our specialists to avail price packages to patients, to help manage their cost of care.”

In response to CNA's query on what the two hospitals would have to demonstrate for certificates to be issued again, Great Eastern said it encouraged policyholders to contact its medical care concierge for information on their "various options" for treatment. 

"This includes suggesting private and public hospitals where they could seek treatment, along with their respective costs and how much Great Eastern will cover for each, depending on the type of plan they hold," said the spokesperson. 

"This service has been specially designed to provide peace of mind, transparency, and help them make informed decisions."

MOH ENGAGING GREAT EASTERN

In response to media queries, the Ministry of Health (MOH) said on Thursday that it was engaging Great Eastern to "better understand the impact of its decision". 

IPs are commercial products, and while the ministry regulates the key parameters of these products 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, said MOH. 

"However, 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," it added. 

OTHER INSURERS

In response to CNA's query on whether AIA Singapore would be pausing pre-authorisation certificates to the hospitals, the company said on Wednesday that it continues to work closely with the Life Insurance Association of Singapore, MOH and professional medical associations to manage healthcare cost inflation to ensure the continued accessibility of quality healthcare for policyholders.

AIA Singapore did not state if it has a pre-authorisation arrangement with the Mount Elizabeth hospitals and if so, if it would continue with the coverage in the wake of Great Eastern's move.

Prudential Singapore said on Thursday that PRUshield customers with eligible plans can submit pre-authorisation requests from any healthcare institution before hospitalisation. 

"We recognise the importance of ensuring healthcare remains accessible and premiums affordable for customers," said the company.

"As such, we prudently manage our Integrated Shield Plan (IP) portfolio to ensure its long-term sustainability in meeting customer needs."

When asked for its comments on whether the two Mount Elizabeth hospitals charged higher prices than other private hospitals, Prudential Singapore said it has observed that "the median claim costs at certain private hospitals are higher than others for similar procedures".

In response to CNA's queries on whether it would pause the certificates to the hospitals, Income Insurance said on Thursday that it does not practise pre-authorisation.