Some good may come out of uproar over health insurance pre-authorisation

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.

- Salma Khalik

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.