How are patients affected if health insurers deny pre-authorisation?

Insurance group Great Eastern (GE) announced on June 17 that it had temporarily stopped issuing pre-authorisation certificates for policyholders admitted to Mount Elizabeth hospitals.

- Judith Tan

Mount Elizabeth and Mount Elizabeth Novena hospitals had higher costs than other private hospitals, GE said, adding that its move was aimed at "prioritising facilities that deliver the same high-quality care with greater cost transparency and cost-effectiveness".

The decision took both the hospitals and GE policyholders by surprise.

The Straits Times looks at how withholding pre-authorisation certificates may affect health-care and hospitalisation coverage of policyholders.

WHAT IS A PRE-AUTHORISATION CERTIFICATE?

Some health insurance plans require the doctor of its policyholder to request a pre-authorisation certificate before doing specific procedures.

A pre-authorisation certificate effectively confirms that the insurer has approved the medical treatment, including the costs, before the treatment begins.

Without getting pre-approval, some or all of the bill may not be covered by insurance, leaving the patient to pay for it himself.

HOW DOES THE PRE-AUTHORISATION WORK?

This process helps the insurer assess whether a treatment recommended by the doctor is medically necessary, and at a reasonable cost.