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Doctors have to be satisfied with TPAs' reasons for tiered fee charges: SMC

DOCTORS who pay to join the panels of third party administrators (TPAs) that set out the reasons for having a tiered fee structure and are satisfied that such charges reflect the amount of work TPAs will do, will not be in breach of the revised ethical guideline on TPAs' fees, which is to take effect from July 1.

In a comment issued to medical practitioners on Friday, the Singapore Medical Council said one such rationale for higher administrative fees is where the claims involve greater complexity of work to be done by the TPAs.

But SMC said that "if two cases within the same tier of complexity are charged different fees, such a fee structure may appear to be based primarily on the services the doctor provides or the fees he or she collects, rather than the complexity of work required of the third party".

In this instance, a doctor who joins the TPA with such a fee structure "may be in breach of the guideline".

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On the issue of quatum of the fees TPAs charge doctors who sign up with them, SMC said this is a function of market forces and business costs.

It added that "each doctor must assess the reasonableness of the quantum of these fees, bearing in mind that whatever quantum he or she chooses to pay must not compromise the proper care of his or her patients".

SMC's comments come after it issued on June 23 its second advisory on the payment of fees to managed care companies, TPAs, insurance entities or patient referral services.

The council said following the second advisory, it was made aware that some TPAs have amended their fee structures or have explained or elaborated further on the basis of their fees. It also continued to receive queries from doctors on whether these amended fee structures are in compliance with the new ethical guideline.

In recent weeks, TPAs had revised their fee structures but doctors remain divided on whether to join the panels.

TPAs are typically engaged by insurers and companies providing employee health benefits to manage such costs.