Need for Upfront Settlement of Bills by Patients Fully Covered by Insurance Policies upon Discharge from Hospital
Ministry of HealthSpeakers
Summary
This question concerns why fully insured patients must pay hospital bills upfront and whether the payment process can be streamlined for policyholders. Dr Lim Wee Kiak raised concerns about reimbursement delays, prompting Minister for Health Gan Kim Yong to explain that Class B2 and C patients generally avoid deposits. However, private and higher-class ward patients may require upfront payments because hospitals face uncertainty regarding individual insurance policy terms and exclusions. To address this, Minister for Health Gan Kim Yong stated that hospitals can waive deposits if insurers provide a Letter of Guarantee for the estimated bill. Currently, all Integrated Shield Plan insurers issue these letters, typically covering up to $10,000, to assist patients who meet the insurers' eligibility criteria.
Transcript
20 Dr Lim Wee Kiak asked the Minister for Health (a) what is the reason for holders of health insurance policies being required to pay first and be reimbursed later after they are discharged from hospitalisation even though they are fully covered by their insurance policies; and (b) whether the Ministry can look into streamlining the payment process for policy holders who are fully covered by their insurance plans.
Mr Gan Kim Yong: With the implementation of MediShield Life for all Singaporeans, we have streamlined our processes so that Singapore Citizens who choose Class B2 or C wards will not need to pay deposits. There is an exception of a small number of patients, who will need to pay a deposit if they choose Class B2 against financial counselling advice so as to encourage them to choose the class they can better afford. The public hospitals will also advise patients who need help with their healthcare bills and discuss with them options for assistance.
For private patients who choose private hospitals or Class A or B1 wards in the public hospitals, their bills are much higher as they do not enjoy the heavy subsidy for B2/C wards. Thus, hospitals may require them to make upfront payment, such as a deposit pre-admission, to cover their estimated hospitalisation cost. Once the bill and the insurance payout are finalised, they will be reimbursed for any excess payments.
Even if the patient has private insurance, hospitals have no certainty over the patient’s insurance payout, given the range of private insurance policies with different coverage, terms and exclusions for pre-existing conditions. Therefore, they may collect a deposit. However, hospitals may waive or reduce the deposit if the patient’s insurer issues an upfront Letter of Guarantee to cover all or part of the estimated bill. Today, all the six Integrated Shield Plan insurers issue Letters of Guarantee, usually with coverage of up to $10,000, if the patient meets their criteria.