SINGAPORE - 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.

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 healthcare 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.

For the policyholder, it ensures that the treatment is covered under the plan. It also keeps out-of-pocket expenses in check, allowing the insurer to settle the medical bill directly with the hospital.

Through the pre-authorisation process, the insurer helps ensure the policyholder receives cost-effective treatments.

What is a letter of guarantee (LOG)?

Non-panel specialists and government hospitals require a letter of guarantee (LOG).

It provides assurance of payment to hospitals on behalf of patients for the portion of their medical bills covered by insurance, reduces the upfront cash deposit the hospital requires, and makes healthcare more accessible and affordable for patients.

How does a patient apply for the pre-authorisation and LOG?

In Singapore, patients may need both the LOG and the pre-authorisation certificate before undergoing surgery.

To apply for both, the patient needs to consult his doctor, who will then submit a pre-authorisation request to the ...