Insurer Great Eastern pauses pre-authorisation certificates for Mount Elizabeth admissions

Insurance group Great Eastern (GE) has temporarily stopped issuing pre-authorisation certificates for policyholders admitted to Mount Elizabeth hospitals from June 17.

The insurer said in a message to its panel doctors that high costs from both Mount Elizabeth and Mount Elizabeth Novena hospitals, compared to 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.

It may cover the cost of the procedure, medications, and other related expenses. Patients who are policyholders have a clear understanding of the costs that will be covered, reducing the risk of unexpected medical bills.

GE told doctors its 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”.

It said its policyholders can still seek care from the two hospitals with no change to their benefits and claims, and that claims would be processed according to the usual procedures.

In response to queries from The Straits Times, a spokesman for GE said: “Since pre-authorisation certificates confirm coverage and guarantee the claims before admission, we are temporarily pausing these for the specified hospitals, as this helps us address the issue of rising charges from the two hospitals.”

The Mount Elizabeth hospitals are owned by IHH Healthcare, the largest private healthcare provider in Singapore, with four acute hospitals.

Its other two hospitals – Gleneagles and Parkway East – are not affected by GE’s suspension of pre-authorisation.

Mr Yong Yih Ming, chief operating officer of IHH Healthcare Singapore and chief executive officer of Mount Elizabeth Hospital, told The Straits Times the group had been in “active discussion with GE over the past few months and are therefore surprised by GE’s unilateral move to suspend pre-authorisation for two of our hospitals before we could conclude the discussion”.

He said the group did not agree with GE’s claim that prices at the two Mount Elizabeth hospitals were higher than other private 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.

Mr Yong assured GE health policyholders that they would continue to have access to the care they need.

Patients may be in the midst of active medical care by specialists at both the Mount Elizabeth hospitals, or have past treatment records there. He said these patients would continue to have cashless access to hospital admissions and do not need to worry about cash outlay, despite GE’s withdrawal of pre-authorisation.

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

The changes by GE caught policyholders by surprise.

A management consultant who wanted to be known only as Mrs D. Ong, 45, said she would expect to be informed of this decision by GE early “since I pay a premium amount annually”.

“The many years of payment have come to this. At almost $4,000 a year for the last 15 years, I expect to be able to choose which hospital I go to for treatment and able to get a pre-authorisation certificate from the insurers. This does not give me any peace of mind if I’m going to be hospitalised,” she said.

When told that GE will assess claims according to the terms and conditions of the policy and that all eligible and covered claims will be paid, Mrs Ong said the insurer “keeps changing policies without informing policyholders, so how would I know whether my claims will be reimbursed after assessment?”

Agreeing, realtor Jeremias Teo, 38, said: “The hospital bill might go into five figures, maybe even more. This is not something a lot of people can fork out, then wait for days and weeks for it to be reimbursed after the insurers approve of the claims.”

As Singapore ages, healthcare spending is expected to rise significantly. Health Minister Ong Ye Kung has said before that insurance companies will need to examine their products, as overly generous and ultimately unsustainable benefits would lead to higher costs for everyone.

GE, a subsidiary of OCBC Bank with a presence in Singapore and Malaysia, has more than $85 billion in assets and over four million policyholders.

The spokesman for GE said the insurer has observed that, over the past few years, certain private hospitals have been charging significantly more for similar treatment or the same clinical outcomes.

As part of its ongoing efforts to manage rising healthcare costs and ensure long-term affordability for all policyholders, “we are in active discussions with the hospital group involved”.

He said: “We would like to reassure all our policyholders that there is no change to their coverage, they can still receive treatment and submit claims as usual, with no impact to their benefits... the claims will be assessed according to the terms and conditions of their policy and all eligible and covered claims will be paid.”

He added that by temporarily pausing pre-authorisation for the specified hospitals, it “helps us address the issue of rising charges from the two hospitals”.

“These efforts are part of our responsibility to keep protection accessible and sustainable for everyone,” he said.

In January, GE reduced the coverage for its Integrated Shield Plans (IPs) significantly, so when someone with a public hospital Class A IP policy chooses to go to a private hospital instead, the policyholder will have only 35 per cent of the bill covered by insurance – down from 70 per cent previously.

Source: The Straits Times © SPH Media Limited. Permission required for reproduction.

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