Great Eastern suspends pre-authorisation certificates for Mount Elizabeth admissions due to higher costs than other private hospitals

Insurance group Great Eastern (GE) has temporarily suspended pre-authorisation certificates for policyholders admitted to Mount Elizabeth Hospitals from Tuesday, Jun. 17.

What is pre-authorisation?

According to The Straits Times (ST), pre-authorisation is a service in which health insurance providers review and approve the medical procedures involved, and confirm the coverage for medical costs even before an insured member's treatment begins. 

This ensures that the proposed care is medically necessary and patients who are policyholders will have a clear understanding of which costs will be covered, and reduce the risk of unexpected medical bills.

In a message to the panel doctors, The Business Times reported the insurer saying that the reason for this decision stems from the high costs from Mount Elizabeth and Mount Elizabeth Novena hospitals, as compared to other private hospitals.

“We have observed that average hospital charges at these two facilities are consistently higher than those at comparable private hospitals for similar procedures and case profiles.”

Which they said would affect the insurance affordability for customers.

“This has a direct impact on out-of-pocket expenses and insurance affordability for our customers.”

Additionally, GE stated that it aims to prioritise facilities "that deliver the same high-quality care with greater cost transparency and cost-effectiveness”.

GE assured the doctors that the decision is not a reflection of the quality of their care, and that policyholders can continue to receive treatment at the two hospitals with no impact on their benefits or claims, which will be processed as per the usual procedures.

Mount Elizabeth Hospital CEO, Yong Yih Ming, told ST that the group did not agree with GE's claim that the two Mount Elizabeth hospitals were higher than other private hospitals for "similar procedures and case profiles".

They said the group had been in active discussion with GE over the past few months, and were surprised at this "unilateral move" before concluding the discussion.

MOH responds

In response to media queries regarding GE’s suspension of pre-authorisation certificates for Mount Elizabeth hospitals, Ministry of Health (MOH) acknowledged that the ability to afford major medical expenses is "understandably a concern" for Singaporeans.

MOH reiterated that Singaporeans are covered by MediShield Life, which is sized to provide coverage for large subsidised bills.

Should they require additional coverage, Singaporeans are also able to purchase Integrated Shield Plans (IPs).

“As these are commercial products, while the Ministry of Health (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.”

MOH highlighted that although insurers are allowed to make changes to their administrative processes, they would still 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.

MOH is "currently engaging" GE to further understand the impact of their decision.

Top photo via Great Eastern and Mount Elizabeth