How to Do Pre-authorisation for Integrated Shield Plans
In recent years, insurers in Singapore introduced several approaches to manage the claim expenses on Integrated Shield Plans. One of them is pre-authorisation. Pre-authorisation means that before the actual hospitalisation or surgery bill is incurred in a private hospital, the insurer communicates with the attending doctor to understand the estimated expenses and assess the medical history of the patient. Once the pre-authorisation is approved, the insurer will issue a Letter of Guarantee to cover the upcoming bill. On one hand, pre-authorisation enhances the ability of the insurer to manage the claim expenses. On the other hand, it also makes it clear for the policy holder how much the insurer will pay and how much is the co-payment before the actual bill is incurred. It is a win-win approach for both sides. In practice, how to apply pre-authorisation? Let me share with you in this article.
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Under non-emergency situation, a patient usually visits a specialist clinic for consultation. After consulting the specialist and the diagnosis is clear, the admission date for hospitalisation or surgery will be scheduled.
When selecting a specialist, you must be cautious because nowadays under every insurer there is a panel of private specialists. If a patient selects a specialist in the panel, the co-payment by the patient will be lesser. If you have a preferred specialist, and unfortunately this specialist is not in the panel, you should at least find out whether the insurer allows pre-authorisation under such situation. If the insurer does not allow, you need to prepare to pay the bill by yourself upon discharge from the hospital, and then claim from the insurer.
After selecting the specialist, you may contact your insurance agent or call the Letter of Guarantee hotline of the insurer and inform them of your intention of visiting the specialist. And then the insurer can communicate with the specialist and prepare for the pre-authorisation.
Next, when you have consulted the specialist and confirmed that hospitalisation or surgery is required, you should try to schedule the admission date to be at least one week later. This will allow the insurer sufficient time to assess your case and complete the pre-authorisation, and you will know how much the insurer will pay and how much is the co-payment before the hospitalisation or surgery.
Under emergency situation, a patient is usually admitted to a hospital through the Accident & Emergency Department in the hospital. In such situation, the patient may unlikely be able to choose an attending doctor. Some insurers offer flexible treatment for such situation, where they recognise the actual attending doctor as a specialist in their panel.
Anyway, under emergency situation, the priority is to treat the patient. When the patient is admitted to the hospital, the patient or a family member or a friend may contact the insurance agent or call the Letter of Guarantee hotline of the insurer and inform them of the medical condition of the patient, the names of the hospital and the attending doctor. This will allow the insurer to do an emergency pre-authorisation. If the patient stays in the hospital for a relatively short time, the insurer may not be able to complete the pre-authorisation before the discharge. In this case, the patient will need to pay the bill first and then claim from the insurer. If the patient stays in the hospital for a relatively long time, the insurer will be able to complete the pre-authorisation before the discharge. In this case, the patient only needs to pay the co-payment portion of the bill upon discharge.
Above is my sharing about the process of pre-authorisation for Integrated Shield Plans. When you are going for hospitalisation or surgery, just stay calm and communicate clearly with your insurance agent or the insurer. Nowadays the claim procedures for Integrated Shield Plans are usually quite smooth. Welcome contacting me for a discussion if you have any questions.