Great Eastern stops Mount Elizabeth pre-authorisation

Great Eastern, the largest insurer in Singapore, has stopped issuing pre-authorisation certificates for Mount Elizabeth Hospital and Mount Elizabeth Novena Hospital. This comes in the midst of OCBC’s attempt to delist Great Eastern. OCBC owns 93.72% of Great Eastern, which has been suspended from trading since last year due.

This post is written with the help with my good friend Sheng Yao. If you need any insurance advice, feel free to hit him up! He is one of the few good guys out there who does right by their clients. 

What is a Pre-Authorisation Certificate (CPA) in Singapore?

Healthcare insurance in Singapore, and around the world, is complex. Having insurance doesn’t mean all your medical treatments will be covered. The insurer has the right to decide what they would provide coverage for, and to what extent they would provide coverage.

This is where documentation like a certificate of pre-authorisation or letter of guarantee comes in handy. It is also something that you want to be familiar with so you don’t get slapped with a massive bill at the end of your hospital stays.

A pre-authorisation certificate confirms that the insurer will be covering the costs before the treatment begins. Your doctor will submit your medical details to the insurer for approval. The assessment by the insurer can take up to three working days. Once approved, you will be issued with a certificate of pre-authorisation, which will include the coverage amount for your treatment and hospitalisation.

*Do note that you may have a co-payment portion to cover yourself!

Without a pre-authorisation letter, you may need to pay upfront first then apply for reimbursement with your insurer later. However, reimbursement is not guaranteed.

Currently, other insurers such as AIA and Prudential are still offering pre-authorisation certificates at Mount Elizabeth hospitals for now.

What is a Letter of Guarantee (LOG)?

A Letter of Guarantee (LOG) is not the same as a CPA. You can think of it as a lesser form of CPA. It is a payment assurance letter that promises the hospital it will cover the bill up a certain amount (i.e., not the full bill).

I honestly think it’s super confusing so we can start with some basics. First, both LOG and CPA are not guaranteed. You can apply to your insurer but not receive any. Furthermore, LOG is subjected to acceptance by your hospital. It is theoretically possible for an insurer to issue a LOG that is not accepted by a hospital. If that is the case, you would have to pay the deposit upfront and the fee of your treatment at the end of your hospital stay.

Pre-authorisation is the best cos it covers everything. From deposit to the treatment you will be receiving. It gives you a peace of mind that you don’t have a bill to settle at the end of the hospital stay.

Letter of Guarantee is usually enough to cover for hospital deposit, so you don’t have to worry about that when you are first admitted. However, it only cover part of the hospitalisation bill. You will have to pay at the end of your hospital stay first then make a claim with your insurer later. Do note that approval is not guaranteed. So if LOG, you may still end up having to pay.

Don’t forget your 5% co-payment

To make matters even more complex, you may have a 5% (or more) c0-payment depending on when you signed up for your Integrated Shield Plan. If you bought your policy before 8 March 2018, there is a chance you don’t have a co-pay. If your integrated shield plan started after on or after 8 March 2018, you will have at least a 5% co-pay.

The minimum 5% c0-payment requirement is set by Ministry of Health in 2018. There is no get around.

To make matters even more confusing, some insurers announced they will be adding a co-payment to policies purchased prior to the stipulated date required by Ministry of Health. So, if you are not sure, just check with your financial advisor or insurance agent.

Great Eastern sending strong message to private hospitals in Singapore

According to Great Eastern, some private hospitals are charging more for same treatments, and even for procedures that are less complex. Interesting, Prudential Singapore had also shared similar observations, though they are still issuing pre-authorisation certificates. It doesn’t sound like what Great Eastern is doing is unreasonable, despite the uproar from some doctors, including the president of Singapore Medical Association Dr Ng Chee Kwan.

It is important to clarify that Great Eastern is not changing their claim payouts or claim eligibility. Patients who want to go to Mount Elizabeth can continue to do so. They can continue to apply to a letter of guarantee to waive the hospital deposit, which has not changed. What changed is that these patients would need to pay for their hospitalisation bill upfront then make a claim with Great Eastern later.

Because claim eligibility and payout remains the same, whatever you is claimable should remain the same. The only difference is the inconvenience and not having the certainty of a pre-authorisation, which is issued before a procedure. Aka, the peace of mind of knowing your bills will be paid for before your treatment.

Continuity of care is not the same as convenience of care

I think medical specialists who are complaining have missed the point. Ultimately, this move by Great Eastern is going to benefit consumers and their patients in the longer term. Based on what has been reported, doctors do often see their patients are multiple private hospitals. Patients who no longer wish to be seen at Mount Elizabeth can be seen at another hospital without disrupting continuity of care.

Yes, I can imagine convenience of care is interrupted. In which case, it will depend on if your patient is willing to pay their hospital bill upfront then claim later to enjoy that said convenience.

There are also how talks about Mount Elizabeth facilities may be preferred, and that the familiarity with the doctors and staff may lead to less medical errors. Um, sure. Again, claim eligibility has not changed. It may be inconvenient to some patients, sure. But no one is saying your patient still cannot go to Mount Elizabeth or that Great Easter is no longer providing coverage for these patients!

Mount Elizabeth, not the medical specialists, are charging the higher fees

Great Eastern had further clarified that the higher fees are likely coming from the hospitals but not the doctors. The higher bills are coming from operating theatre and ward fees, as well as consumers.

In other words, the doctors are kinda sandwiched between. Although medical specialists from Mount Elizabeth have fees that are reported to be consistent across the board and comparable to Ministry of Health fees benchmark, they may be losing patients with the latest GE move.

Ultimately, patients may not want to risk having their claims refuted and would prefer to proceed with a hospital that will allow them to receive a pre-authorisation.

Hopefully this incident will put more pressure on private hospitals to relook their fee structure. Specifically, the lobster and celebrity chef menus.

Does Mount Elizabeth charge more than other hospitals?

According to Great Eastern, yes. This question is not easily answered by the public because we don’t have access to the same numbers as the insurers. However, CNA did do a comparison of a typical bill between private hospitals in Singapore in 2023.

The number published is based on the median cost paid by patients. The procedures covered include knee arthroscopy, ligament reconstruction (e.g., torn ACL of the knee) appendicectomy, caesarean section, among others. Out of the 10 procedures listed, Mount Elizabeth Orchard and Novena charged the most for six.

Both Mouth Elizabeth hospitals are owned by IHH Healthcare, which also owned Gleneagles Hospital and Parkway East Hospital. Out of the ten procedures, nine of the most expensive were by the IHH Healthcare group. Farrer Park Hospital charges the most for iridectomy, a surgery to remove part of the iris.

Public hospitals offers better standard of care than private hospitals

If given a choice, I would always opt for treatment in a public hospital as a private patient. This will give you benefits such as short to no waiting time for specialist appointments, and you can also choose your preferred doctor. Given that Singapore General Hospital is currently ranked 9th in the world, public hospitals are honestly pretty good.

Mount Elizabeth Hospital Orchard is ranked 111th, below National University Hospital (NUH) and Tan Tock Seng Hospital. None of the other private hospitals made it in the Newsweek’s World’s Best Hospital top 250th list (2025).

Besides being better than private hospitals, public hospitals also make a lot more sense if you are a minimalist. Private hospitals offer way too much bells and whistles. I mean, do we really need hospitals to collaborate with Chef Sam Leong? Being in the press for serving food like wok-fried lobster is also not what I look for in a hospital.

The crazy thing about all of this to me is such extravagance is going to drive hospital bills up, which is ultimate borne by the consumers. If you have been paying your insurance premiums but have never stayed in a private hospital, you may very well be contributing to someone’s lobster dinner.

Free market economy is better for business

Yes, yes, I get that we live in an open economy in Singapore. Businesses can do whatever they want, within the constraints of law, as long as consumers are willing to pay for it. That means Mount Elizabeth can charge whatever they want. That also means Great Eastern can withdraw their pre-authorisation privilege whenever they want.

In my opinion, it is the greater society who ends up paying the bills for these extra frills offered by private hospitals, that have no impact on treatment outcome. Who do you think benefits the most?

IHH Healthcare net profit for last year was RM $1.9b or SGD $573m. They are definitely making money!

Remember when our health minister Ong Ye Kung as ‘dismayed’ at $52k per month rent for a medical clinic in Tampines? I would love to hear what he has to say about this. Both are private  healthcare operators and, if anything, more scrutiny should be paid to private hospital fees. Thankfully, Ministry of Health is said to be already in talks with GE.

You pay what you get for

I do agree that you pay what you get for. In the case of Mount Elizabeth, what you get is not better healthcare. What you get is a better brand and a pianist in the lobby. You also get to see their Guan Gong mural and Ming Dynasty vase, though you cannot bring these home.

Don’t take my word for it. The founder of Novo AI, Julien Condamines, has echoed the same sentiments about how private hospitals are not always better for the consumers. According to Julien’s Linkedin Post, NOVO AI worked directly with hospitals to process thousands of pre-authorisation requests every month.

What they see are:

• Exaggerated length of stay
• Needless lab exams
• Premature surgeries without the necessary documentation
• Admissions for patients who could be out the same day, and
• Treatments charged differently for the same condition

Same hospital, same operating room, same medical staff… if you recover in a private room, the same surgery will be 2x to 4x more expensive than if you stay in a shared room. What the… ?!

What thing Julien mentioned that I didn’t know is that patients who stay in different rooms gets a different price for their surgery. According to him, the disparity can be double, and up to four times more. It is clear there is something very brokek about the private hospital industry in Singapore.

Disadvantages of being a private patient in a public hospital

I think my disdain towards certain aspects of private hospital offerings in Singapore is clear. As mentioned earlier, my most ideal preference would be a private fee patient in a public hospital. However, this is not always advisable because of the longer term implications.

When you are a private fee patient in a public hospital, you are no longer eligible for subsidies that are available to public fee patients. Insurance may cover your procedures and hospital stay, but they do not cover outpatient care.

No matter your condition is, you are going to incur outpatient fees after you are discharged from hospital. This fee will need to be paid out of pocket.

Furthermore, you cannot reverse your fee status from private to public.

Unfortunately, this means patients who cannot wait for their procedure or to work with their allocated specialist will have to turn to private hospital for treatment. This will allow patients to have their procedure fees covered by their Integrated Shield Plan while still retaining their public fee status in public hospitals.

Is chiropractic insurance coverage affected with Great Eastern’s move?

Thankfully, chiropractic insurance coverage from Great Eastern are not affected by this news as they are under a completely different policy product. Unlike what I have seen in foreign insurers, pre-authorisation is not an option among local insurers. All chiropractic treatments would have to be paid upfront first. You can then put in a claim for your chiropractic care. Once approved, you will be reimbursed accordingly.

Great Eastern policies that include coverage for chiropractic include Essential Protector Plus and AccidentCare Plus II.

Don’t try to game the insurance game

Ultimately, insurance is there to help with healthcare costs. It is not something for us to abuse or to try to make a “profit” out of. In the short term, treatments at private hospitals with all the bells and whistles may seem like good value for money. In the longer term, however, the consumers are the ones who will pay for it.

Earlier this year, it was reported that premiums for integrated shield plans (IPs) are expected to increase. As a result of this increase, some Singaporeans are anticipated to downgrade private health insurance policies. This came after the government approval to increase MediShield Life premiums. The premiums are expected to increase up to a whopping 35%!

Lastly, please do not try to cheat your insurer. I have had several instances where people asked if I could lie on the invoices so they could make a claim. The short answer is no. It seems trivial and like something you may not get caught for. But that’s not true and it’s 100% not worth the risk. In 2019, chiropractor Charles Loo Boon Ann, who was a director of Chiropractic Focus Group was sentenced to eight months jail for insurance fraud.