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IP insurers urged to grow size of panels, enhance pre-approval process for treatments

SINGAPORE – All Integrated Shield Plan (IP) insurers have been encouraged by the Ministry of Health (MOH) to grow the size of their panels, make their panel selection criteria more transparent and enhance the process of pre-authorising hospitalisation or treatments to minimise the risk of runaway bill sizes, Senior Minister of State for Health Koh Poh Koon said in Parliament yesterday.

While policyholder benefits may differ depending on whether a patient sees a panel doctor or a non-panel doctor who is pre-authorised, they should not prohibit patients from seeing non-panel doctors or influence patient choices in an undesirable way, said Dr Koh.

This comes in the wake of a recent fight between the Singapore Medical Association (SMA) and the Life Insurance Association (LIA) over the relatively small number of doctors on insurers’ panels.

Currently, more than 70 per cent of private specialists are on at least one panel, said Dr Koh.

Some policyholders have expressed concernbecause their long-time doctor is not on the panel of their IP insurer and they cannot switch insurers as their pre-existing conditions will not likely be covered. They also cannot enjoy the benefits that come with seeing a panel doctor, such as having a $3,000 co-payment cap.

To put things in perspective, Dr Koh said that as less than 3 per cent of inpatient bills in private hospitals today exceed $60,000, the vast majority of inpatient bills do not hit the cap.

He also said that MOH will study if IP insurance can be made fully portable and spoke about claims scrutiny by insurers, which may have been seen as challenging a doctor’s professional judgement.

“Insurers should not make the process onerous and ask for unnecessary information unrelated to the claims, imposing a heavy administrative burden on the clinicians,” said Dr Koh.

Dr Lim Wee Kiak (Sembawang GRC) had asked about the process of empanelling specialist doctors and whether IP insurers can challenge the opinions of specialists after they had rendered treatment to patients.

Dr Koh said the information sought for common conditions can be standardised and streamlined so it will not be perceived as questioning the decisions and judgement of the doctors.

“If a particular claim is justified, insurers should pay according to the policy benefits,” said Dr Koh, who added: “We will be looking into this issue.”

Another point of contention that some doctors had with IP insurers was that they tended to be compensated at the lower end of MOH’s surgeon fee benchmarks.

Dr Koh said that according to LIA data, between 5 per cent and 15 per cent of IP claims for surgeon fees were approved above the upper bound of the fee benchmarks, depending on the insurer.

The 12-member Multilateral Healthcare Insurance Committee (MHIC), which was set up recently to resolve issues related to IP plans, will make information on healthcare bills, claims and premiums more transparent. It will also establish a claims complaints process for stakeholders, supported by the Academy of Medicine, Singapore (AMS) and LIA.

The committee will examine issues from a patient and consumer-centric viewpoint through a sub-committee led by the Consumers Association of Singapore (Case).

The committee stems from an earlier pro tem committee established last October between AMS, LIA and SMA. It comprises representatives from AMS, Case, the Fee Benchmarks Advisory Committee, LIA, SMA and private hospitals.

Reference