Pre-authorization, also known as pre-approval, is a process where health insurance providers review and approve certain medical treatments or procedures before they are performed. 

This makes sure that the proposed care is medically necessary and covered under the policy, helping to manage healthcare costs and prevent unexpected expenses for policyholders.

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The Pre-Authorization Process in Singapore

In Singapore, the pre-authorization process typically involves several key steps:

1. Consultation with Healthcare Provider: The patient consults with their doctor, who recommends a specific treatment or procedure.

2. Submission of Pre-Authorization Request: The healthcare provider submits a pre-authorization request to the patient’s insurance company. This request includes relevant medical information, such as diagnosis, proposed treatment plan, and estimated costs.

3. Insurer’s Review: The insurance company reviews the submitted information to determine if the proposed treatment is covered under the patient’s policy and if it meets the criteria for medical necessity.

4. Approval or Denial: The insurer communicates its decision to the healthcare provider and the patient. If approved, the insurer may issue a Letter of Guarantee (LOG), assuring direct payment to the hospital for covered expenses. If denied, the patient may need to discuss alternative treatments or funding options with their doctor.

Benefits of Pre-Authorization

Obtaining pre-authorization offers several advantages:

• Financial Clarity: Patients gain a clear understanding of which costs will be covered by insurance, reducing the risk of unexpected medical bills.
• Assurance of Coverage: Pre-authorization confirms that the proposed treatment aligns with the policy’s coverage terms, providing peace of mind to the patient.
• Cost Management: Insurers can better control and predict healthcare costs, helping to maintain the overall sustainability of healthcare funding.

Pre-Authorization in Singapore’s Integrated Shield Plans 

Integrated Shield Plans (IPs) in Singapore typically include pre-authorization processes to improve claim transparency and efficiency. The Life Insurance Association (LIA) Singapore has introduced standardized pre-authorization forms to simplify the process, reducing administrative burdens on doctors and ensuring consistency across insurers. Learn more: Insurance Business

According to the Ministry of Health (MOH), the median processing time for pre-authorization requests varies by insurer, usually taking between zero to three days. In other words, 50 out of 100 pre-authorization requests are processed within this time, starting from when all required documents and clarifications are received.

Considerations and Best Practices

While pre-authorization offers significant benefits, patients and healthcare providers should be mindful of the following:

• Timely Submission: Submitting pre-authorization requests well in advance of the planned treatment date is crucial. For example, Allianz Care advises sending the completed pre-authorization form at least five working days before the treatment.
• Emergency Situations: Pre-authorization is generally not required for emergency treatments, including COVID-19 cases, as eligible claims are accepted automatically. Learn more: AIA Singapore
• Policy Awareness: Patients should familiarize themselves with their insurance policy terms to understand which treatments require pre-authorization and the specific procedures to follow.