Choosing a healthcare provider: Insurer panels can save time and costs

Choosing the right healthcare provider can be a complex decision, influenced by factors like availability, cost, trust, and comfort. For policyholders of health insurers, selecting a specialist from the insurer's integrated shield plan (IP) main panel offers a streamlined approach to managing medical care.

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Choosing one from your health insurer’s preferred panel can help save time and manage costs when medical care is needed.

These empanelled healthcare providers work closely with insurers to deliver quality, cost-effective treatment at pre-negotiated rates within selected private hospitals and medical centers in Singapore. This partnership aims to make healthcare costs more predictable, reduce out-of-pocket expenses, and simplify the claims process for policyholders.

Prudential Singapore, for instance, provides its PruShield plan policyholders with electronic letters of guarantee (eLOG) and pre-authorization services. An eLOG can waive or reduce the upfront cash deposit needed before hospital admission, up to the policy's guaranteed amount. Pre-authorization allows the insurer to review upcoming treatments, assess coverage, and provide policyholders with a clearer understanding of their expected out-of-pocket expenses. These services are generally accepted by panel specialists, and in some cases, policyholders may be eligible for cashless benefits without needing to submit a pre-authorization request.

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Choosing an empanelled doctor can make costs more predictable, reduce out-of-pocket expenses and smooth the claims process.

While policyholders can still seek pre-authorization for treatments with non-panel specialists, they might not benefit from cashless hospital transactions, potentially leading to higher out-of-pocket costs. IP riders can help offset some co-insurance costs for non-panel claims, but they typically cover only up to half of the co-insurance, and the policy's stop-loss feature, which caps annual co-insurance payments, does not apply to non-panel providers. This means there's no upper limit on co-payment when using non-panel specialists.

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The purpose of an eLOG is to waive or reduce the upfront cash deposit required before hospital admission, up to the guaranteed amount.

However, in emergencies requiring hospital admission, treatment at an authorized accident and emergency department is immediate, and the stop-loss feature on an IP rider usually applies regardless of the doctor's panel status. The alignment of panel providers with insurer guidelines on medical fees generally results in a smoother claims process for patients.

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Through pre-authorisation, the insurer reviews upcoming hospital treatments to assess whether the procedure is covered, giving policyholders greater clarity on their policy coverage and expected out-of-pocket expense.