Medical body president concerned over Great Eastern pausing pre-authorisation for Mount Elizabeth admissions
SINGAPORE: Great Eastern's suspension of pre-authorisation certificates for policyholders admitted to Mount Elizabeth hospitals could disrupt 'continuity of care' for patients, the president of the Singapore Medical Association (SMA) said.
Dr Ng Chee Kwan told CNA that the insurer's move limits its policyholders' choice of doctors and discourages them from using the two hospitals.
Other doctors with clinics in the two affected hospitals also voiced concerns about Great Eastern's decision.
Last Tuesday (Jun 17), the insurer halted pre-authorisation certificates for admissions to Mount Elizabeth hospitals in Orchard and Novena, citing 'efforts to manage rising healthcare costs and ensure long-term affordability for all policyholders'.
According to Great Eastern, it had observed certain private hospitals charging 'significantly more for similar treatment' over the past few years.
Pre-authorisation refers to an insurer's approval of coverage for medical costs before treatment.
It 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.
These pre-approved bills are settled directly by the insurer with the hospital. Without pre-authorisation, patients have to pay for their treatments first, before filing their claims for assessment.
Dr Ng, who is on Great Eastern's specialists panel and whose clinic is at Mount Elizabeth Novena, said: 'Because integrated shield plans are not portable, many policyholders may not be able to change insurers even if they are unhappy.'
According to him, the insurer 'entered into partnerships with some hospitals' this year.
'Although I can admit patients to (Great Eastern's) preferred hospitals, for major cases it is not so ideal,' he said.
He added that one of the insurer's preferred facilities does not have the necessary equipment for some of the major surgeries he performs.
Dr Tan Yung Khan, a urologist who has clinics in both Mount Elizabeth hospitals and Mount Alvernia Hospital, said the insurer's move meant less certainty for patients as to whether their claims would go through.
'The lack of certainty will weigh on patients' minds and discourage them from certain hospitals,' he added.
Dr Tan, who is also on Great Eastern's specialist panel, pointed out that private doctors are often accredited in different facilities and can operate in them.
'For example, I can see a patient in Mount Elizabeth Novena, and I often do, and I end up doing cases in (Mount) Alvernia, or even certain day surgery centres,' he added.
However, he noted that certain factors would make doctors keen to use the same location.
The benefits of using their usual facility are that the doctors and staff know each other's usual practices, and this may lead to 'more efficiency and possibly fewer errors', he said.
'If let's say you're doing a major surgery, you would rather be in a location that has facilities, in a sense, that you trust,' he added.
'Oftentimes, if you practise somewhere before, you have the confidence that they can support you.'
COMPLICATES DECISIONS FOR PATIENTS
Dr Peter Ang, an oncologist at OncoCare Cancer Centre, said he 'felt dismayed' after hearing about Great Eastern's decision.
'It does complicate the decisions our cancer patients need to make for their health care,' he said.
'On top of medical decisions when patients are unwell, they need to navigate the financial aspects, which they often have difficulty finding answers to.'
Dr Ang is also on Great Eastern's specialist panel, but said last Friday that he had not had any patients who were Great Eastern policyholders since the announcement.
When asked about how the move could affect his clinic, he said some of their patients might need to be admitted to various hospital locations for tests, investigations or treatment.
'So that would mean some logistical arrangement among our group of doctors,' he said.
OncoCare Cancer Centre has clinics at the two affected hospitals, as well as Mount Alvernia and Gleneagles.
Dr Tan said the move had no impact on his clinic for now, likely because they did not have any Great Eastern policyholders scheduled for surgery at the two hospitals at the moment.
'But, of course, moving down the road, things may be different because of the uncertainty,' he said.
'Patients may rather choose somewhere where they have more certainty on their claims … fees have gone up quite a lot, and if there's no certainty, there's a risk that there is no payment,' he said.
While he was 'a bit shocked' at Great Eastern's move, Dr Tan said he could understand the decision as healthcare costs have been rising.
'I think if we can control overall costs in some way, I think it's a good thing because everyone benefits out of the whole system,' he said. 'I buy insurance, too. I don't want my premiums to keep rising either.'
GREAT EASTERN RESPONDS
In response to CNA's queries, Great Eastern said on Thursday that the suspension does not impact its policyholders' coverage or benefits.
'Customers can still choose to visit these two hospitals,' it said.
For planned procedures or surgeries, the affected hospitals can issue an electronic letter of guarantee, which will be used to request a waiver of deposit on admission, added the insurer.
A letter of guarantee reduces or waives the upfront cash deposit required for treatment and provides assurance of payment to hospitals for part of the bill. It is different from a pre-authorisation certificate.
Great Eastern said customers can continue to file claims to be assessed, and that all eligible and covered claims would be paid.
The insurer still issues pre-authorised certificates for treatments at other private hospitals, such as Mount Alvernia, Farrer Park, Gleneagles and Raffles.
The insurer's medical care concierge will provide customers with 'various options' for treatment, including suggesting private and public hospitals where they can seek treatment.
REMOVAL OF PANEL SPECIALISTS
Dr Ng noted that Great Eastern removed more specialists from its panel in 2024 than any other insurer.
In response to CNA's question about the drop in its panel specialists, Great Eastern said it does an annual review of its panel to ensure that doctors provide quality service to its patients and 'offer reasonable fees aligned to MOH (Ministry of Health) guidelines'.
According to data from the Ministry of Health (MOH), Great Eastern and AIA were the only insurers that saw net decreases in the number of specialists on their panels last year.
While AIA saw its panel shrink by 13 specialists, the drop in Great Eastern's specialists was four times this, at 52. This meant the number of specialists on Great Eastern's panel fell by about 15 per cent.
Despite this, Great Eastern still had the third highest number of panel specialists, with 779.
Dr Ng said the partnerships Great Eastern entered into with some hospitals this year could explain why he had not seen any of the insurer's policyholders in a while.
'I hope that Great Eastern and the affected hospitals will come to an agreement soon and restore the pre-authorisation arrangement,' he added.
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