KUALA LUMPUR: In a clear directive to the insurance industry, the finance ministry has stated that insurance and takaful operators (ITOs) and third-party administrators (TPAs) are not permitted to prescribe or dictate medical treatment for patients.
The statement from deputy finance minister Lim Hui Ying comes amid growing criticism from the medical community over alleged interference by these companies in clinical decisions. She emphasized that the sole authority to determine a patient’s care rests with their doctor.
“If a specific treatment is not covered by a patient’s insurance policy, the responsibility for payment would then fall on the patient personally,” Lim told the Dewan Rakyat.
Addressing Industry-Wide Concerns
The minister’s clarification was in response to a question from Sim Tze Tzin (PH-Bayan Baru), who highlighted several pressing issues following Bank Negara Malaysia’s recent measures to curb rising medical insurance premiums. The problems cited included:
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Interference by ITOs in clinical decisions.
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Last-minute retractions of guarantee letters.
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Claim rejections based on alleged non-adherence to treatment protocols.
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Sharp premium increases linked to age brackets.
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Reduced coverage periods for policyholders.
Reactivating the Grievance Mechanism
In response to these challenges, Lim announced that the government, in collaboration with the central bank, medical professionals, hospitals, and ITOs, will be reactivating the Grievance Mechanism Committee (GMC).
This committee is tasked with addressing operational disputes within the industry, with a focus on reducing delays in issuing guarantee letters and resolving conflicts over coverage.
The Malaysian Medical Association (MMA) had previously raised the alarm over a specific circular from a TPA that directed healthcare providers on anaesthesia choices and procedure classifications. MMA president, Dr. R. Thirunavukarasu, condemned such directives, stating they constitute a breach of medical ethics and an infringement on clinical autonomy.